Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $99.53 / $101.84 / $576.83	Facility	26	$99.53	$101.84	$576.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $803.91 / $987.18 / $4,963.22	Professional		$803.91	$987.18	$4,963.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $715.44 / $884.48 / $4,394.97	Professional	TC	$715.44	$884.48	$4,394.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $351.30 / $910.02 / $2,090.31	Professional		$351.30	$910.02	$2,090.31
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $354.13 / $796.90 / $1,809.17	Professional	TC	$354.13	$796.90	$1,809.17
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $220.77 / $325.99 / $819.51	Professional		$220.77	$325.99	$819.51
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $133.54 / $195.44 / $504.79	Professional	TC	$133.54	$195.44	$504.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $433.07 / $1,097.67 / $2,756.70	Professional		$433.07	$1,097.67	$2,756.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $324.68 / $953.27 / $2,484.67	Professional	TC	$324.68	$953.27	$2,484.67
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $1,262.38 / $1,388.62 / $1,704.21	Professional		$1,262.38	$1,388.62	$1,704.21
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $106.68 / $117.35 / $144.02	Professional	26	$106.68	$117.35	$144.02
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,155.70 / $1,271.27 / $1,560.20	Professional	TC	$1,155.70	$1,271.27	$1,560.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $956.74 / $1,261.29 / $2,079.38	Professional		$956.74	$1,261.29	$2,079.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $92.57 / $133.35 / $224.96	Professional	26	$92.57	$133.35	$224.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $890.61 / $1,355.05 / $2,172.71	Professional	TC	$890.61	$1,355.05	$2,172.71
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $287.14 / $478.18 / $478.18	Facility	26	$287.14	$478.18	$478.18
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,422.07 / $6,422.07 / $7,978.20	Professional		$6,422.07	$6,422.07	$7,978.20
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,800.59 / $5,800.59 / $7,141.13	Professional	TC	$5,800.59	$5,800.59	$7,141.13
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 $436.14 / $1,121.29 / $2,622.43	Professional		$436.14	$1,121.29	$2,622.43
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $295.47 / $953.27 / $2,395.84	Professional	TC	$295.47	$953.27	$2,395.84
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $2,855.93 / $2,855.93 / $2,855.93	Professional		$2,855.93	$2,855.93	$2,855.93
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $2,528.94 / $2,528.94 / $2,528.94	Professional	TC	$2,528.94	$2,528.94	$2,528.94
United Facility/Professional Professional Modifier Low / Median / High Price $523.78 / $1,082.69 / $2,728.78	Professional		$523.78	$1,082.69	$2,728.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $318.87 / $950.06 / $2,542.54	Professional	TC	$318.87	$950.06	$2,542.54