Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $235.94 / $1,011.09 / $9,132.00	Facility		$235.94	$1,011.09	$9,132.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.81 / $54.39 / $476.49	Facility	26	$51.81	$54.39	$476.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.12 / $235.72 / $424.02	Professional		$128.12	$235.72	$424.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.86 / $62.44 / $235.09	Professional	26	$48.86	$62.44	$235.09
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $64.06 / $91.96 / $464.91	Professional	52	$64.06	$91.96	$464.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.77 / $184.12 / $348.12	Professional	TC	$65.77	$184.12	$348.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $113.99 / $113.99 / $113.99	Professional		$113.99	$113.99	$113.99
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $58.82 / $71.04 / $175.73	Professional	26	$58.82	$71.04	$175.73
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $57.43 / $570.00 / $876.00	Facility		$57.43	$570.00	$876.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $168.89 / $302.22 / $700.73	Professional		$168.89	$302.22	$700.73
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.80 / $87.12 / $316.07	Professional	26	$57.80	$87.12	$316.07
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $78.42 / $230.80 / $516.46	Professional	TC	$78.42	$230.80	$516.46
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $59.40 / $1,185.70 / $5,332.99	Facility		$59.40	$1,185.70	$5,332.99
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $169.11 / $275.12 / $609.77	Professional		$169.11	$275.12	$609.77
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $49.81 / $60.25 / $149.30	Professional	26	$49.81	$60.25	$149.30
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $130.38 / $215.70 / $468.21	Professional	TC	$130.38	$215.70	$468.21
Cigna Facility/Professional Facility Modifier Low / Median / High Price $146.07 / $7,675.00 / $15,820.61	Facility		$146.07	$7,675.00	$15,820.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.06 / $94.06 / $94.06	Facility	26	$94.06	$94.06	$94.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $137.41 / $276.73 / $701.20	Professional		$137.41	$276.73	$701.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.18 / $77.90 / $205.31	Professional	26	$56.18	$77.90	$205.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $73.89 / $177.37 / $583.79	Professional	TC	$73.89	$177.37	$583.79
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $136.13 / $177.50 / $239.63	Professional		$136.13	$177.50	$239.63
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.93 / $85.41 / $115.30	Professional	26	$44.93	$85.41	$115.30
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $91.21 / $92.09 / $124.32	Professional	TC	$91.21	$92.09	$124.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $135.85 / $179.25 / $308.98	Professional		$135.85	$179.25	$308.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.87 / $103.37 / $160.57	Professional	26	$76.87	$103.37	$160.57
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $73.67 / $106.61 / $172.85	Professional	TC	$73.67	$106.61	$172.85
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $883.12 / $1,600.36 / $2,025.75	Facility		$883.12	$1,600.36	$2,025.75
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $188.75 / $386.03 / $386.03	Facility	26	$188.75	$386.03	$386.03
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,102.49 / $3,195.57 / $3,195.57	Professional		$3,102.49	$3,195.57	$3,195.57
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $551.37 / $551.37 / $667.80	Professional	26	$551.37	$551.37	$667.80
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,808.09 / $2,892.33 / $2,892.33	Professional	TC	$2,808.09	$2,892.33	$2,892.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $98.49	Professional		$32.34	$32.34	$98.49
Providence Facility/Professional Facility Modifier Low / Median / High Price $148.37 / $233.03 / $904.67	Facility		$148.37	$233.03	$904.67
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $94.06 / $94.06 / $94.06	Facility	26	$94.06	$94.06	$94.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $146.07 / $298.64 / $644.04	Professional		$146.07	$298.64	$644.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $57.20 / $74.59 / $178.52	Professional	26	$57.20	$74.59	$178.52
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $175.02 / $175.02 / $175.02	Professional	52	$175.02	$175.02	$175.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $73.89 / $195.03 / $601.98	Professional	TC	$73.89	$195.03	$601.98
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $535.04 / $535.04 / $535.04	Professional		$535.04	$535.04	$535.04
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $273.52 / $273.52 / $273.52	Professional	26	$273.52	$273.52	$273.52
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $261.51 / $261.51 / $261.51	Professional	TC	$261.51	$261.51	$261.51
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $143.40 / $197.18 / $631.00	Professional		$143.40	$197.18	$631.00
United Facility/Professional Facility Modifier Low / Median / High Price $172.28 / $172.28 / $172.28	Facility		$172.28	$172.28	$172.28
United Facility/Professional Professional Modifier Low / Median / High Price $165.77 / $210.91 / $535.91	Professional		$165.77	$210.91	$535.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.25 / $88.42 / $203.02	Professional	26	$44.25	$88.42	$203.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.67 / $130.79 / $385.07	Professional	TC	$78.67	$130.79	$385.07