Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.81 / $28.60 / $158.81	Facility	26	$25.81	$28.60	$158.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $127.04 / $160.36 / $322.98	Professional		$127.04	$160.36	$322.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.46 / $132.36 / $281.33	Professional	TC	$103.46	$132.36	$281.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $99.43 / $148.81 / $302.76	Professional		$99.43	$148.81	$302.76
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.47 / $112.83 / $237.84	Professional	TC	$51.47	$112.83	$237.84
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $91.78 / $127.85 / $308.39	Professional		$91.78	$127.85	$308.39
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $73.51 / $102.70 / $250.61	Professional	TC	$73.51	$102.70	$250.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $94.42 / $183.13 / $451.21	Professional		$94.42	$183.13	$451.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.57 / $157.34 / $386.44	Professional	TC	$63.57	$157.34	$386.44
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $123.15 / $147.78 / $317.44	Professional		$123.15	$147.78	$317.44
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.31 / $54.19 / $77.89	Professional	26	$30.31	$54.19	$77.89
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $55.42 / $66.50 / $276.52	Professional	TC	$55.42	$66.50	$276.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $170.58 / $220.75 / $371.52	Professional		$170.58	$220.75	$371.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.08 / $30.63 / $54.73	Professional	26	$25.08	$30.63	$54.73
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $158.05 / $204.83 / $358.45	Professional	TC	$158.05	$204.83	$358.45
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $62.61 / $121.12 / $132.62	Facility	26	$62.61	$121.12	$132.62
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $964.87 / $964.87 / $1,490.25	Professional		$964.87	$964.87	$1,490.25
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $798.40 / $798.40 / $1,274.84	Professional	TC	$798.40	$798.40	$1,274.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $247.17	Professional		$32.34	$32.34	$247.17
Providence Facility/Professional Professional Modifier Low / Median / High Price $107.63 / $232.90 / $426.87	Professional		$107.63	$232.90	$426.87
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $63.32 / $156.88 / $333.30	Professional	TC	$63.32	$156.88	$333.30
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $445.32 / $445.32 / $445.32	Professional		$445.32	$445.32	$445.32
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $356.57 / $356.57 / $356.57	Professional	TC	$356.57	$356.57	$356.57
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $147.78 / $213.96 / $264.97	Professional		$147.78	$213.96	$264.97
United Facility/Professional Professional Modifier Low / Median / High Price $101.25 / $142.50 / $386.16	Professional		$101.25	$142.50	$386.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.68 / $113.89 / $347.38	Professional	TC	$77.68	$113.89	$347.38