Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $74.13 / $245.47	Facility	26	$38.02	$74.13	$245.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $123.03 / $478.63	Professional		$83.18	$123.03	$478.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $83.18 / $363.08	Professional	TC	$51.29	$83.18	$363.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $190.55 / $354.81	Professional		$131.83	$190.55	$354.81
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $128.82 / $245.47	Professional	TC	$81.28	$128.82	$245.47
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $194.98 / $346.74	Professional		$134.90	$194.98	$346.74
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $138.04 / $251.19	Professional	TC	$93.33	$138.04	$251.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $45.71 / $64.57	Facility	26	$9.77	$45.71	$64.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $169.82 / $302.00	Professional		$89.13	$169.82	$302.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $123.03 / $223.87	Professional	TC	$53.70	$123.03	$223.87
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $144.54 / $194.98	Professional		$81.28	$144.54	$194.98
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $46.77 / $63.10	Professional	26	$35.48	$46.77	$63.10
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $97.72 / $131.83	Professional	TC	$46.77	$97.72	$131.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $138.04 / $239.88	Professional		$107.15	$138.04	$239.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $53.70 / $87.10	Professional	26	$40.74	$53.70	$87.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $107.15 / $186.21	Professional	TC	$81.28	$107.15	$186.21
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $251.19 / $251.19 / $251.19	Facility	26	$251.19	$251.19	$251.19
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,148.15 / $1,148.15	Professional		$1,148.15	$1,148.15	$1,148.15
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $933.25 / $933.25 / $933.25	Professional	TC	$933.25	$933.25	$933.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $46.77 / $104.71	Professional		$32.36	$46.77	$104.71
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $45.71 / $64.57	Facility	26	$9.77	$45.71	$64.57
Providence Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $177.83 / $295.12	Professional		$89.13	$177.83	$295.12
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $123.03 / $218.78	Professional	TC	$53.70	$123.03	$218.78
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $338.84 / $338.84	Professional		$338.84	$338.84	$338.84
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $208.93 / $208.93	Professional	TC	$208.93	$208.93	$208.93
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $162.18 / $229.09	Professional		$117.49	$162.18	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $125.89 / $263.03	Professional		$93.33	$125.89	$263.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $81.28 / $181.97	Professional	TC	$57.54	$81.28	$181.97