Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.09 / $46.62 / $263.44	Facility	26	$44.09	$46.62	$263.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $153.03 / $250.86 / $1,319.25	Professional		$153.03	$250.86	$1,319.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $124.48 / $196.21 / $1,062.72	Professional	TC	$124.48	$196.21	$1,062.72
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $231.60 / $327.02 / $665.98	Professional		$231.60	$327.02	$665.98
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $184.54 / $265.27 / $538.16	Professional	TC	$184.54	$265.27	$538.16
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $185.68 / $286.24 / $679.38	Professional		$185.68	$286.24	$679.38
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $150.72 / $234.73 / $558.87	Professional	TC	$150.72	$234.73	$558.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $195.05 / $301.99 / $671.51	Professional		$195.05	$301.99	$671.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $170.69 / $259.56 / $567.00	Professional	TC	$170.69	$259.56	$567.00
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $268.54 / $268.54 / $362.53	Professional		$268.54	$268.54	$362.53
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.64 / $47.64 / $64.31	Professional	26	$47.64	$47.64	$64.31
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $220.89 / $220.89 / $298.20	Professional	TC	$220.89	$220.89	$298.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $201.30 / $265.80 / $472.10	Professional		$201.30	$265.80	$472.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.15 / $56.98 / $99.96	Professional	26	$39.15	$56.98	$99.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $169.60 / $244.88 / $415.27	Professional	TC	$169.60	$244.88	$415.27
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $101.86 / $198.60 / $210.24	Facility	26	$101.86	$198.60	$210.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,396.18 / $1,438.07 / $1,718.10	Professional		$1,396.18	$1,438.07	$1,718.10
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,165.91 / $1,200.89 / $1,373.85	Professional	TC	$1,165.91	$1,200.89	$1,373.85
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 $194.87 / $293.80 / $667.69	Professional		$194.87	$293.80	$667.69
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $176.12 / $264.18 / $567.00	Professional	TC	$176.12	$264.18	$567.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $759.11 / $759.11 / $759.11	Professional		$759.11	$759.11	$759.11
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $611.52 / $611.52 / $611.52	Professional	TC	$611.52	$611.52	$611.52
United Facility/Professional Professional Modifier Low / Median / High Price $196.02 / $246.06 / $658.25	Professional		$196.02	$246.06	$658.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $156.76 / $196.90 / $595.72	Professional	TC	$156.76	$196.90	$595.72