Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.53 / $22.62 / $136.25	Facility	26	$20.53	$22.62	$136.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.72 / $47.88 / $156.00	Professional		$31.72	$47.88	$156.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.55 / $22.53 / $91.30	Professional	26	$19.55	$22.53	$91.30
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.81 / $50.03 / $109.59	Professional		$35.81	$50.03	$109.59
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.18 / $29.02 / $57.19	Professional	26	$22.18	$29.02	$57.19
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $24.47 / $34.76 / $87.97	Professional		$24.47	$34.76	$87.97
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.25 / $20.35 / $50.88	Professional	26	$14.25	$20.35	$50.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.30 / $24.30 / $24.30	Facility	26	$24.30	$24.30	$24.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.54 / $60.06 / $155.44	Professional		$37.54	$60.06	$155.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.76 / $30.26 / $75.28	Professional	26	$22.76	$30.26	$75.28
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $31.19 / $65.23 / $88.07	Professional		$31.19	$65.23	$88.07
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.71 / $24.24 / $32.72	Professional	26	$18.71	$24.24	$32.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $47.85 / $59.94 / $165.00	Professional		$47.85	$59.94	$165.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.76 / $24.24 / $52.84	Professional	26	$19.76	$24.24	$52.84
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.69 / $84.39 / $106.12	Facility	26	$50.69	$84.39	$106.12
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $352.79 / $352.79 / $426.98	Professional		$352.79	$352.79	$426.98
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $140.68 / $140.68 / $171.23	Professional	26	$140.68	$140.68	$171.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.26 / $32.34 / $71.87	Professional		$30.26	$32.34	$71.87
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $24.30 / $24.30 / $24.30	Facility	26	$24.30	$24.30	$24.30
Providence Facility/Professional Professional Modifier Low / Median / High Price $38.88 / $66.00 / $144.40	Professional		$38.88	$66.00	$144.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.76 / $29.44 / $62.97	Professional	26	$22.76	$29.44	$62.97
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $159.56 / $159.56 / $159.56	Professional		$159.56	$159.56	$159.56
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $75.97 / $75.97 / $75.97	Professional	26	$75.97	$75.97	$75.97
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $40.54 / $52.76 / $72.55	Professional		$40.54	$52.76	$72.55
United Facility/Professional Professional Modifier Low / Median / High Price $31.44 / $45.90 / $121.14	Professional		$31.44	$45.90	$121.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.63 / $23.70 / $54.34	Professional	26	$17.63	$23.70	$54.34