Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $354.81 / $741.31	Facility		$147.91	$354.81	$741.31
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $87.10 / $194.98	Facility	26	$47.86	$87.10	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $91.20 / $204.17	Professional		$54.95	$91.20	$204.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $54.95 / $186.21	Professional	26	$28.18	$54.95	$186.21
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $83.18 / $158.49 / $380.19	Professional	50	$83.18	$158.49	$380.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $37.15 / $100.00	Professional	TC	$15.14	$37.15	$100.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $44.67 / $114.82	Professional		$33.11	$44.67	$114.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $67.61 / $489.78	Professional	26	$67.61	$67.61	$489.78
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $48.98 / $60.26 / $162.18	Professional	50	$48.98	$60.26	$162.18
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $48.98 / $257.04	Facility		$43.65	$48.98	$257.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $125.89 / $208.93	Professional		$79.43	$125.89	$208.93
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $57.54 / $104.71	Professional	26	$40.74	$57.54	$104.71
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $75.86 / $100.00 / $302.00	Professional	50	$75.86	$100.00	$302.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $64.57 / $107.15	Professional	TC	$32.36	$64.57	$107.15
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $165.96 / $363.08	Facility		$66.07	$165.96	$363.08
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $117.49 / $208.93	Professional		$83.18	$117.49	$208.93
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $64.57 / $117.49	Professional	26	$45.71	$64.57	$117.49
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $53.70 / $97.72	Professional	TC	$36.31	$53.70	$97.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $239.88 / $691.83	Facility		$36.31	$239.88	$691.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.24 / $33.88 / $48.98	Facility	26	$7.24	$33.88	$48.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $104.71 / $190.55	Professional		$47.86	$104.71	$190.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $54.95 / $97.72	Professional	26	$29.51	$54.95	$97.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $50.12 / $104.71	Professional	TC	$20.42	$50.12	$104.71
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $61.66 / $83.18	Professional		$42.66	$61.66	$83.18
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $37.15 / $50.12	Professional	26	$23.99	$37.15	$50.12
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $25.70 / $34.67	Professional	TC	$19.05	$25.70	$34.67
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $60.26 / $102.33	Professional		$46.77	$60.26	$102.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $42.66 / $75.86	Professional	26	$31.62	$42.66	$75.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $28.84 / $48.98	Professional	TC	$20.42	$28.84	$48.98
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $338.84 / $338.84 / $338.84	Facility		$338.84	$338.84	$338.84
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $199.53 / $199.53 / $199.53	Facility	26	$199.53	$199.53	$199.53
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $676.08 / $676.08	Professional		$676.08	$676.08	$676.08
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $338.84 / $338.84 / $338.84	Professional	26	$338.84	$338.84	$338.84
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $416.87 / $416.87	Professional	TC	$416.87	$416.87	$416.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $44.67 / $87.10	Professional		$36.31	$44.67	$87.10
Providence Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $95.50 / $213.80	Facility		$48.98	$95.50	$213.80
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $7.24 / $33.88 / $48.98	Facility	26	$7.24	$33.88	$48.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $104.71 / $181.97	Professional		$47.86	$104.71	$181.97
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $54.95 / $97.72	Professional	26	$28.18	$54.95	$97.72
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $51.29 / $109.65	Professional	TC	$18.62	$51.29	$109.65
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $173.78 / $173.78	Professional		$173.78	$173.78	$173.78
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $104.71 / $104.71	Professional	26	$104.71	$104.71	$104.71
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $70.79 / $70.79	Professional	TC	$70.79	$70.79	$70.79
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $69.18 / $162.18	Professional		$51.29	$69.18	$162.18
United Facility/Professional Facility Modifier Low / Median / High Price $165.96 / $169.82 / $263.03	Facility		$165.96	$169.82	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $74.13 / $151.36	Professional		$47.86	$74.13	$151.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $38.90 / $79.43	Professional	26	$28.84	$38.90	$79.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $30.90 / $67.61	Professional	TC	$19.05	$30.90	$67.61