Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.64 / $33.59 / $216.03	Facility	26	$31.64	$33.59	$216.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.15 / $91.31 / $247.19	Professional		$73.15	$91.31	$247.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.39 / $33.49 / $149.22	Professional	26	$28.39	$33.49	$149.22
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $214.11 / $359.52 / $973.29	Professional	50	$214.11	$359.52	$973.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.92 / $55.88 / $128.63	Professional	TC	$40.92	$55.88	$128.63
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.28 / $119.70 / $234.64	Professional		$89.28	$119.70	$234.64
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.79 / $46.61 / $90.19	Professional	26	$35.79	$46.61	$90.19
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $114.13 / $129.69 / $167.34	Professional	50	$114.13	$129.69	$167.34
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $53.48 / $72.70 / $150.13	Professional	TC	$53.48	$72.70	$150.13
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $69.22 / $90.69 / $221.62	Professional		$69.22	$90.69	$221.62
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $27.63 / $35.00 / $97.47	Professional	26	$27.63	$35.00	$97.47
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $41.60 / $56.31 / $138.63	Professional	TC	$41.60	$56.31	$138.63
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.24 / $36.24 / $36.24	Facility	26	$36.24	$36.24	$36.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.65 / $120.59 / $261.66	Professional		$82.65	$120.59	$261.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.49 / $43.96 / $98.23	Professional	26	$30.49	$43.96	$98.23
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $145.44 / $145.44 / $145.44	Professional	50	$145.44	$145.44	$145.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.57 / $77.06 / $170.98	Professional	TC	$50.57	$77.06	$170.98
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $66.43 / $95.30 / $128.66	Professional		$66.43	$95.30	$128.66
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.91 / $37.32 / $50.38	Professional	26	$23.91	$37.32	$50.38
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.52 / $57.98 / $78.27	Professional	TC	$42.52	$57.98	$78.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $74.12 / $96.76 / $181.14	Professional		$74.12	$96.76	$181.14
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.22 / $45.98 / $77.30	Professional	26	$32.22	$45.98	$77.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $68.03 / $113.76	Professional	TC	$46.77	$68.03	$113.76
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $93.26 / $145.31 / $161.31	Facility	26	$93.26	$145.31	$161.31
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $583.91 / $603.17 / $618.45	Professional		$583.91	$603.17	$618.45
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $335.18 / $335.18 / $335.18	Professional	26	$335.18	$335.18	$335.18
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $353.01 / $360.07 / $360.45	Professional	TC	$353.01	$360.07	$360.45
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $51.77	Professional		$32.34	$32.34	$51.77
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $36.24 / $36.24 / $36.24	Facility	26	$36.24	$36.24	$36.24
Providence Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $132.58 / $241.74	Professional		$85.11	$132.58	$241.74
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $30.82 / $42.27 / $96.06	Professional	26	$30.82	$42.27	$96.06
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $51.83 / $77.26 / $170.98	Professional	TC	$51.83	$77.26	$170.98
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $333.38 / $333.38 / $333.38	Professional		$333.38	$333.38	$333.38
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $118.75 / $118.75 / $118.75	Professional	26	$118.75	$118.75	$118.75
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $214.62 / $214.62 / $214.62	Professional	TC	$214.62	$214.62	$214.62
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $77.08 / $105.99 / $161.99	Professional		$77.08	$105.99	$161.99
United Facility/Professional Professional Modifier Low / Median / High Price $64.42 / $101.41 / $306.61	Professional		$64.42	$101.41	$306.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.45 / $36.81 / $103.67	Professional	26	$24.45	$36.81	$103.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $64.59 / $166.84	Professional	TC	$37.15	$64.59	$166.84