Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.10 / $29.80 / $187.60	Facility	26	$28.10	$29.80	$187.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $65.00 / $79.12 / $166.11	Professional		$65.00	$79.12	$166.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.02 / $29.53 / $74.81	Professional	26	$26.02	$29.53	$74.81
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $77.06 / $215.77 / $224.94	Professional	50	$77.06	$215.77	$224.94
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $28.47 / $35.01 / $193.05	Professional	52	$28.47	$35.01	$193.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.04 / $49.53 / $93.67	Professional	TC	$37.04	$49.53	$93.67
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $78.09 / $102.34 / $196.19	Professional		$78.09	$102.34	$196.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.02 / $40.36 / $78.18	Professional	26	$31.02	$40.36	$78.18
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $98.25 / $120.25 / $165.15	Professional	50	$98.25	$120.25	$165.15
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $46.41 / $61.69 / $114.92	Professional	TC	$46.41	$61.69	$114.92
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $60.29 / $79.04 / $189.98	Professional		$60.29	$79.04	$189.98
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.94 / $30.54 / $83.34	Professional	26	$23.94	$30.54	$83.34
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $36.34 / $49.26 / $117.68	Professional	TC	$36.34	$49.26	$117.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.84 / $33.84 / $33.84	Facility	26	$33.84	$33.84	$33.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $65.78 / $100.89 / $210.73	Professional		$65.78	$100.89	$210.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.61 / $38.21 / $85.89	Professional	26	$26.61	$38.21	$85.89
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $97.82 / $97.82 / $97.82	Professional	50	$97.82	$97.82	$97.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.97 / $62.89 / $132.15	Professional	TC	$39.97	$62.89	$132.15
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $54.82 / $87.22 / $117.75	Professional		$54.82	$87.22	$117.75
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.73 / $35.21 / $47.53	Professional	26	$19.73	$35.21	$47.53
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.08 / $52.01 / $70.20	Professional	TC	$35.08	$52.01	$70.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $67.81 / $88.26 / $151.00	Professional		$67.81	$88.26	$151.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.27 / $43.29 / $72.75	Professional	26	$30.27	$43.29	$72.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $41.61 / $61.03 / $102.05	Professional	TC	$41.61	$61.03	$102.05
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $78.53 / $136.22 / $151.72	Facility	26	$78.53	$136.22	$151.72
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $497.00 / $497.00 / $566.17	Professional		$497.00	$497.00	$566.17
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $320.31 / $320.31 / $320.31	Professional	26	$320.31	$320.31	$320.31
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $320.31 / $320.31 / $323.63	Professional	TC	$320.31	$320.31	$323.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $47.50	Professional		$32.34	$32.34	$47.50
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $33.84 / $33.84 / $33.84	Facility	26	$33.84	$33.84	$33.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $69.78 / $109.10 / $198.79	Professional		$69.78	$109.10	$198.79
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.75 / $37.09 / $84.81	Professional	26	$26.75	$37.09	$84.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $39.97 / $62.89 / $132.15	Professional	TC	$39.97	$62.89	$132.15
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $222.18 / $222.18 / $222.18	Professional		$222.18	$222.18	$222.18
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $102.52 / $102.52 / $102.52	Professional	26	$102.52	$102.52	$102.52
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $119.65 / $119.65 / $119.65	Professional	TC	$119.65	$119.65	$119.65
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $70.54 / $97.00 / $133.66	Professional		$70.54	$97.00	$133.66
United Facility/Professional Professional Modifier Low / Median / High Price $55.04 / $73.38 / $185.50	Professional		$55.04	$73.38	$185.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.24 / $31.76 / $89.74	Professional	26	$22.24	$31.76	$89.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.63 / $41.10 / $114.63	Professional	TC	$32.63	$41.10	$114.63