Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $181.97 / $575.44	Facility	26	$93.33	$181.97	$575.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $169.82 / $891.25	Professional		$123.03	$169.82	$891.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $61.66 / $346.74	Professional	TC	$42.66	$61.66	$346.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $275.42 / $537.03	Professional		$177.83	$275.42	$537.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $117.49 / $213.80	Professional	TC	$66.07	$117.49	$213.80
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $302.00 / $602.56	Professional		$208.93	$302.00	$602.56
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $117.49 / $251.19	Professional	TC	$83.18	$117.49	$251.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $204.17 / $389.05	Professional		$125.89	$204.17	$389.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $85.11 / $154.88	Professional	TC	$46.77	$85.11	$154.88
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $177.83 / $239.88	Professional		$125.89	$177.83	$239.88
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $104.71 / $141.25	Professional	26	$81.28	$104.71	$141.25
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $74.13 / $100.00	Professional	TC	$43.65	$74.13	$100.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $181.97 / $309.03	Professional		$141.25	$181.97	$309.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $123.03 / $213.80	Professional	26	$89.13	$123.03	$213.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $85.11 / $141.25	Professional	TC	$57.54	$85.11	$141.25
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $588.84 / $588.84 / $588.84	Facility	26	$588.84	$588.84	$588.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,202.26 / $1,202.26	Professional		$1,148.15	$1,202.26	$1,202.26
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $602.56 / $602.56 / $602.56	Professional	TC	$602.56	$602.56	$602.56
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $48.98 / $169.82	Professional		$32.36	$48.98	$169.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $208.93 / $380.19	Professional		$125.89	$208.93	$380.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $87.10 / $151.36	Professional	TC	$45.71	$87.10	$151.36
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $489.78 / $489.78	Professional		$489.78	$489.78	$489.78
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $173.78 / $173.78	Professional	TC	$173.78	$173.78	$173.78
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $162.18 / $213.80	Professional		$125.89	$162.18	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $165.96 / $371.54	Professional		$123.03	$165.96	$371.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $61.66 / $151.36	Professional	TC	$44.67	$61.66	$151.36