Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.45 / $99.87 / $573.90	Facility	26	$94.45	$99.87	$573.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $132.83 / $155.96 / $810.00	Professional		$132.83	$155.96	$810.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.13 / $61.50 / $298.89	Professional	TC	$47.13	$61.50	$298.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $171.12 / $244.02 / $469.27	Professional		$171.12	$244.02	$469.27
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.73 / $89.68 / $194.34	Professional	TC	$64.73	$89.68	$194.34
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $164.04 / $234.72 / $536.41	Professional		$164.04	$234.72	$536.41
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $75.11 / $99.97 / $217.61	Professional	TC	$75.11	$99.97	$217.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $126.66 / $207.13 / $426.27	Professional		$126.66	$207.13	$426.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.76 / $86.49 / $170.05	Professional	TC	$44.76	$86.49	$170.05
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $126.14 / $176.62 / $238.44	Professional		$126.14	$176.62	$238.44
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.99 / $103.35 / $139.52	Professional	26	$81.99	$103.35	$139.52
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.15 / $73.27 / $98.91	Professional	TC	$44.15	$73.27	$98.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $140.99 / $181.07 / $326.95	Professional		$140.99	$181.07	$326.95
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $89.12 / $128.63 / $216.06	Professional	26	$89.12	$128.63	$216.06
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $56.58 / $86.04 / $137.75	Professional	TC	$56.58	$86.04	$137.75
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $219.19 / $454.05 / $454.05	Facility	26	$219.19	$454.05	$454.05
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,161.00 / $1,161.00 / $1,194.83	Professional		$1,161.00	$1,161.00	$1,194.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $585.04 / $602.60 / $602.60	Professional	TC	$585.04	$602.60	$602.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $32.34	Professional		$32.34	$32.34	$32.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $126.86 / $213.79 / $402.75	Professional		$126.86	$213.79	$402.75
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $49.07 / $89.48 / $168.48	Professional	TC	$49.07	$89.48	$168.48
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $493.12 / $493.12 / $493.12	Professional		$493.12	$493.12	$493.12
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $171.99 / $171.99 / $171.99	Professional	TC	$171.99	$171.99	$171.99
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $142.81 / $176.59 / $214.43	Professional		$142.81	$176.59	$214.43
United Facility/Professional Professional Modifier Low / Median / High Price $126.90 / $173.43 / $480.12	Professional		$126.90	$173.43	$480.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.17 / $64.83 / $159.91	Professional	TC	$44.17	$64.83	$159.91