Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.91 / $49.52 / $282.52	Facility	26	$44.91	$49.52	$282.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.72 / $98.85 / $145.56	Professional		$82.72	$98.85	$145.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.23 / $53.95 / $78.02	Professional	TC	$44.23	$53.95	$78.02
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.53 / $104.01 / $211.12	Professional		$70.53	$104.01	$211.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.00 / $48.42 / $99.48	Professional	TC	$21.00	$48.42	$99.48
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $66.75 / $89.57 / $213.91	Professional		$66.75	$89.57	$213.91
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $32.40 / $44.75 / $107.77	Professional	TC	$32.40	$44.75	$107.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.61 / $125.84 / $294.60	Professional		$81.61	$125.84	$294.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.28 / $66.59 / $163.30	Professional	TC	$28.28	$66.59	$163.30
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $109.92 / $120.91 / $148.38	Professional		$109.92	$120.91	$148.38
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.97 / $54.97 / $67.45	Professional	26	$49.97	$54.97	$67.45
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $59.96 / $65.95 / $80.95	Professional	TC	$59.96	$65.95	$80.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $85.07 / $108.67 / $195.00	Professional		$85.07	$108.67	$195.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.54 / $50.00 / $86.25	Professional	26	$41.54	$50.00	$86.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.32 / $59.96 / $97.94	Professional	TC	$46.32	$59.96	$97.94
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $106.02 / $202.83 / $220.31	Facility	26	$106.02	$202.83	$220.31
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $646.83 / $646.83 / $736.05	Professional		$646.83	$646.83	$736.05
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $354.71 / $354.71 / $375.75	Professional	TC	$354.71	$354.71	$375.75
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $131.63	Professional		$32.34	$32.34	$131.63
Providence Facility/Professional Professional Modifier Low / Median / High Price $88.91 / $142.62 / $270.45	Professional		$88.91	$142.62	$270.45
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $27.64 / $66.59 / $146.96	Professional	TC	$27.64	$66.59	$146.96
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $326.69 / $326.69 / $326.69	Professional		$326.69	$326.69	$326.69
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $168.39 / $168.39 / $168.39	Professional	TC	$168.39	$168.39	$168.39
United Facility/Professional Professional Modifier Low / Median / High Price $74.58 / $103.07 / $276.89	Professional		$74.58	$103.07	$276.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.25 / $50.89 / $146.08	Professional	TC	$35.25	$50.89	$146.08