Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.49 / $65.44 / $357.46	Facility	26	$59.49	$65.44	$357.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $360.43 / $461.05 / $796.32	Professional		$360.43	$461.05	$796.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.19 / $65.43 / $107.18	Professional	26	$53.19	$65.43	$107.18
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $177.42 / $214.05 / $333.75	Professional	52	$177.42	$214.05	$333.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $301.69 / $401.68 / $669.99	Professional	TC	$301.69	$401.68	$669.99
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $415.67 / $593.24 / $1,161.02	Professional		$415.67	$593.24	$1,161.02
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.12 / $83.85 / $216.09	Professional	26	$58.12	$83.85	$216.09
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $326.08 / $499.92 / $973.28	Professional	TC	$326.08	$499.92	$973.28
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $330.60 / $495.89 / $1,151.28	Professional		$330.60	$495.89	$1,151.28
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $39.94 / $55.26 / $132.28	Professional	26	$39.94	$55.26	$132.28
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $293.25 / $439.88 / $1,021.23	Professional	TC	$293.25	$439.88	$1,021.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $481.70 / $647.78 / $1,286.56	Professional		$481.70	$647.78	$1,286.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.71 / $88.44 / $171.57	Professional	26	$63.71	$88.44	$171.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $411.91 / $555.89 / $1,120.66	Professional	TC	$411.91	$555.89	$1,120.66
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $211.29 / $321.58 / $744.30	Professional		$211.29	$321.58	$744.30
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.44 / $82.40 / $104.51	Professional	26	$64.44	$82.40	$104.51
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $128.88 / $196.16 / $657.30	Professional	TC	$128.88	$196.16	$657.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $410.65 / $520.48 / $964.83	Professional		$410.65	$520.48	$964.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.62 / $65.12 / $121.15	Professional	26	$53.62	$65.12	$121.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $375.87 / $486.89 / $852.06	Professional	TC	$375.87	$486.89	$852.06
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $141.82 / $495.00 / $495.00	Facility	26	$141.82	$495.00	$495.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,899.13 / $2,986.11 / $3,500.93	Professional		$2,899.13	$2,986.11	$3,500.93
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $873.43 / $873.43 / $873.43	Professional	26	$873.43	$873.43	$873.43
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,483.58 / $2,558.09 / $3,038.18	Professional	TC	$2,483.58	$2,558.09	$3,038.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $556.41	Professional		$32.34	$32.34	$556.41
Providence Facility/Professional Professional Modifier Low / Median / High Price $498.81 / $705.46 / $1,118.78	Professional		$498.81	$705.46	$1,118.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $64.56 / $89.54 / $165.90	Professional	26	$64.56	$89.54	$165.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $425.46 / $569.71 / $1,120.66	Professional	TC	$425.46	$569.71	$1,120.66
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,367.07 / $1,367.07 / $1,367.07	Professional		$1,367.07	$1,367.07	$1,367.07
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $201.17 / $201.17 / $201.17	Professional	26	$201.17	$201.17	$201.17
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,165.89 / $1,165.89 / $1,165.89	Professional	TC	$1,165.89	$1,165.89	$1,165.89
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $316.93 / $501.64 / $613.12	Professional		$316.93	$501.64	$613.12
United Facility/Professional Professional Modifier Low / Median / High Price $333.21 / $494.07 / $1,150.71	Professional		$333.21	$494.07	$1,150.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.23 / $74.97 / $159.21	Professional	26	$49.23	$74.97	$159.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $281.20 / $418.82 / $986.36	Professional	TC	$281.20	$418.82	$986.36