Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.73 / $23.81 / $139.19	Facility	26	$22.73	$23.81	$139.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.12 / $130.49 / $515.74	Professional		$98.12	$130.49	$515.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.12 / $108.34 / $413.33	Professional	TC	$78.12	$108.34	$413.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.92 / $145.38 / $286.97	Professional		$104.92	$145.38	$286.97
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.12 / $113.05 / $228.76	Professional	TC	$79.12	$113.05	$228.76
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $131.58 / $311.02	Professional		$100.00	$131.58	$311.02
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $85.85 / $104.12 / $246.66	Professional	TC	$85.85	$104.12	$246.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.26 / $26.26 / $26.26	Facility	26	$26.26	$26.26	$26.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.62 / $151.47 / $344.10	Professional		$100.62	$151.47	$344.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $78.09 / $120.51 / $307.18	Professional	TC	$78.09	$120.51	$307.18
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $86.52 / $184.90 / $249.62	Professional		$86.52	$184.90	$249.62
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.17 / $25.79 / $34.82	Professional	26	$18.17	$25.79	$34.82
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $68.34 / $159.10 / $214.79	Professional	TC	$68.34	$159.10	$214.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $137.90 / $181.69 / $301.76	Professional		$137.90	$181.69	$301.76
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.80 / $30.95 / $48.49	Professional	26	$22.80	$30.95	$48.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $127.28 / $184.04 / $298.39	Professional	TC	$127.28	$184.04	$298.39
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $113.57 / $113.57	Facility	26	$100.00	$113.57	$113.57
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $923.37 / $923.37 / $1,172.33	Professional		$923.37	$923.37	$1,172.33
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $778.42 / $778.42 / $986.78	Professional	TC	$778.42	$778.42	$986.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $109.30	Professional		$32.34	$32.34	$109.30
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $26.26 / $26.26 / $26.26	Facility	26	$26.26	$26.26	$26.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $107.86 / $177.18 / $383.62	Professional		$107.86	$177.18	$383.62
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $78.09 / $118.32 / $275.72	Professional	TC	$78.09	$118.32	$275.72
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $435.86 / $435.86 / $435.86	Professional		$435.86	$435.86	$435.86
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $357.68 / $357.68 / $357.68	Professional	TC	$357.68	$357.68	$357.68
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $129.78 / $173.75 / $210.98	Professional		$129.78	$173.75	$210.98
United Facility/Professional Professional Modifier Low / Median / High Price $84.13 / $132.09 / $323.95	Professional		$84.13	$132.09	$323.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.50 / $107.55 / $302.61	Professional	TC	$66.50	$107.55	$302.61