Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.07 / $39.96 / $234.96	Facility	26	$38.07	$39.96	$234.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.10 / $129.30 / $339.48	Professional		$90.10	$129.30	$339.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.44 / $88.89 / $248.29	Professional	TC	$56.44	$88.89	$248.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $122.03 / $164.19 / $327.93	Professional		$122.03	$164.19	$327.93
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $77.81 / $114.74 / $244.41	Professional	TC	$77.81	$114.74	$244.41
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $151.52 / $345.88	Professional		$100.00	$151.52	$345.88
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $79.89 / $108.20 / $241.09	Professional	TC	$79.89	$108.20	$241.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.47 / $45.47 / $45.47	Facility	26	$45.47	$45.47	$45.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.39 / $168.33 / $313.00	Professional		$85.39	$168.33	$313.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.89 / $120.26 / $227.63	Professional	TC	$53.89	$120.26	$227.63
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $81.98 / $138.25 / $186.64	Professional		$81.98	$138.25	$186.64
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.25 / $44.47 / $60.03	Professional	26	$35.25	$44.47	$60.03
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.73 / $93.78 / $126.60	Professional	TC	$46.73	$93.78	$126.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.20 / $138.25 / $233.82	Professional		$102.20	$138.25	$233.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.26 / $53.36 / $84.47	Professional	26	$39.26	$53.36	$84.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.30 / $108.45 / $175.86	Professional	TC	$72.30	$108.45	$175.86
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $103.08 / $195.84 / $195.84	Facility	26	$103.08	$195.84	$195.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,114.04 / $1,147.46 / $1,147.46	Professional		$1,114.04	$1,147.46	$1,147.46
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $909.46 / $936.75 / $936.75	Professional	TC	$909.46	$936.75	$936.75
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $64.59	Professional		$32.34	$32.34	$64.59
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $45.47 / $45.47 / $45.47	Facility	26	$45.47	$45.47	$45.47
Providence Facility/Professional Professional Modifier Low / Median / High Price $89.84 / $186.23 / $300.27	Professional		$89.84	$186.23	$300.27
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $54.82 / $123.73 / $227.63	Professional	TC	$54.82	$123.73	$227.63
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $341.12 / $341.12 / $341.12	Professional		$341.12	$341.12	$341.12
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $208.61 / $208.61 / $208.61	Professional	TC	$208.61	$208.61	$208.61
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $111.81 / $153.74 / $227.38	Professional		$111.81	$153.74	$227.38
United Facility/Professional Professional Modifier Low / Median / High Price $103.16 / $127.60 / $284.77	Professional		$103.16	$127.60	$284.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.80 / $86.36 / $206.33	Professional	TC	$62.80	$86.36	$206.33