Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $85.11 / $263.03	Facility	26	$43.65	$85.11	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $234.42 / $1,318.26	Professional		$181.97	$234.42	$1,318.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $194.98 / $1,071.52	Professional	TC	$144.54	$194.98	$1,071.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $371.54 / $776.25	Professional		$263.03	$371.54	$776.25
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $295.12 / $616.60	Professional	TC	$213.80	$295.12	$616.60
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $363.08 / $851.14	Professional		$257.04	$363.08	$851.14
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $302.00 / $676.08	Professional	TC	$208.93	$302.00	$676.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $302.00 / $660.69	Professional		$204.17	$302.00	$660.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $257.04 / $537.03	Professional	TC	$169.82	$257.04	$537.03
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $371.54	Professional		$275.42	$275.42	$371.54
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $48.98 / $66.07	Professional	26	$48.98	$48.98	$66.07
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $223.87 / $302.00	Professional	TC	$223.87	$223.87	$302.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $269.15 / $512.86	Professional		$208.93	$269.15	$512.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $56.23 / $102.33	Professional	26	$42.66	$56.23	$102.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $239.88 / $426.58	Professional	TC	$177.83	$239.88	$426.58
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $275.42 / $275.42 / $275.42	Facility	26	$275.42	$275.42	$275.42
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,445.44 / $1,737.80 / $1,737.80	Professional		$1,445.44	$1,737.80	$1,737.80
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,202.26 / $1,380.38 / $1,380.38	Professional	TC	$1,202.26	$1,380.38	$1,380.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $165.96 / $208.93	Professional		$42.66	$165.96	$208.93
Providence Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $309.03 / $660.69	Professional		$199.53	$309.03	$660.69
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $263.03 / $537.03	Professional	TC	$177.83	$263.03	$537.03
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $758.58 / $758.58	Professional		$758.58	$758.58	$758.58
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $616.60 / $616.60	Professional	TC	$616.60	$616.60	$616.60
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $251.19 / $630.96	Professional		$194.98	$251.19	$630.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $199.53 / $512.86	Professional	TC	$154.88	$199.53	$512.86