Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.31 / $29.65 / $178.63	Facility	26	$28.31	$29.65	$178.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $76.36 / $106.73 / $220.72	Professional		$76.36	$106.73	$220.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.27 / $72.79 / $181.92	Professional	TC	$51.27	$72.79	$181.92
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $88.89 / $127.98 / $269.77	Professional		$88.89	$127.98	$269.77
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $57.72 / $92.45 / $192.14	Professional	TC	$57.72	$92.45	$192.14
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $88.78 / $111.29 / $311.19	Professional		$88.78	$111.29	$311.19
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $61.85 / $79.42 / $242.03	Professional	TC	$61.85	$79.42	$242.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $31.62 / $31.62	Facility	26	$31.62	$31.62	$31.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.31 / $127.58 / $261.73	Professional		$79.31	$127.58	$261.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $92.07 / $194.42	Professional	TC	$53.70	$92.07	$194.42
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $57.11 / $113.39 / $153.08	Professional		$57.11	$113.39	$153.08
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.85 / $30.48 / $41.15	Professional	26	$18.85	$30.48	$41.15
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.26 / $82.91 / $111.93	Professional	TC	$38.26	$82.91	$111.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.55 / $112.30 / $183.80	Professional		$83.55	$112.30	$183.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.99 / $36.58 / $57.30	Professional	26	$26.99	$36.58	$57.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.33 / $96.00 / $155.63	Professional	TC	$66.33	$96.00	$155.63
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $134.57 / $134.57	Facility	26	$100.00	$134.57	$134.57
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $673.71 / $673.71 / $738.53	Professional		$673.71	$673.71	$738.53
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $514.25 / $514.25 / $517.20	Professional	TC	$514.25	$514.25	$517.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $56.94	Professional		$32.34	$32.34	$56.94
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $31.62 / $31.62	Facility	26	$31.62	$31.62	$31.62
Providence Facility/Professional Professional Modifier Low / Median / High Price $83.34 / $141.40 / $258.50	Professional		$83.34	$141.40	$258.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $91.04 / $191.51	Professional	TC	$53.70	$91.04	$191.51
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $324.33 / $324.33 / $324.33	Professional		$324.33	$324.33	$324.33
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $224.24 / $224.24 / $224.24	Professional	TC	$224.24	$224.24	$224.24
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $85.66 / $114.68 / $139.26	Professional		$85.66	$114.68	$139.26
United Facility/Professional Professional Modifier Low / Median / High Price $88.39 / $109.18 / $248.78	Professional		$88.39	$109.18	$248.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.87 / $74.29 / $174.33	Professional	TC	$60.87	$74.29	$174.33