Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $99.44 / $334.96 / $963.91	Facility		$99.44	$334.96	$963.91
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.42 / $51.42 / $189.04	Facility	26	$48.42	$51.42	$189.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $71.45 / $92.48 / $200.00	Professional		$71.45	$92.48	$200.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.93 / $48.70 / $185.65	Professional	26	$31.93	$48.70	$185.65
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $82.23 / $165.74 / $652.41	Professional	50	$82.23	$165.74	$652.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.18 / $41.78 / $86.47	Professional	TC	$18.18	$41.78	$86.47
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $29.56 / $29.56 / $83.82	Professional		$29.56	$29.56	$83.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $210.00 / $210.00 / $210.00	Professional	26	$210.00	$210.00	$210.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $44.42 / $242.57 / $706.00	Facility		$44.42	$242.57	$706.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.23 / $120.61 / $218.42	Professional		$75.23	$120.61	$218.42
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.78 / $61.19 / $110.92	Professional	26	$38.78	$61.19	$110.92
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $80.62 / $94.33 / $152.62	Professional	50	$80.62	$94.33	$152.62
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.14 / $56.87 / $107.83	Professional	TC	$32.14	$56.87	$107.83
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $57.50 / $100.00 / $310.02	Facility		$57.50	$100.00	$310.02
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $74.08 / $95.75 / $217.94	Professional		$74.08	$95.75	$217.94
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $41.45 / $52.08 / $121.08	Professional	26	$41.45	$52.08	$121.08
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $32.63 / $43.99 / $100.00	Professional	TC	$32.63	$43.99	$100.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $40.61 / $274.73 / $681.32	Facility		$40.61	$274.73	$681.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.29 / $34.29 / $34.29	Facility	26	$34.29	$34.29	$34.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.07 / $109.19 / $214.63	Professional		$52.07	$109.19	$214.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.41 / $55.95 / $119.56	Professional	26	$31.41	$55.95	$119.56
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $90.51 / $90.51 / $90.51	Professional	50	$90.51	$90.51	$90.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.42 / $50.17 / $115.54	Professional	TC	$21.42	$50.17	$115.54
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $43.09 / $59.01 / $79.66	Professional		$43.09	$59.01	$79.66
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.13 / $35.00 / $47.25	Professional	26	$24.13	$35.00	$47.25
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.96 / $24.01 / $32.40	Professional	TC	$18.96	$24.01	$32.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $46.83 / $61.06 / $107.80	Professional		$46.83	$61.06	$107.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.22 / $43.12 / $72.47	Professional	26	$30.22	$43.12	$72.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $19.63 / $28.23 / $47.20	Professional	TC	$19.63	$28.23	$47.20
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $103.10 / $338.68 / $338.68	Facility		$103.10	$338.68	$338.68
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $70.02 / $198.78 / $198.78	Facility	26	$70.02	$198.78	$198.78
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $659.45 / $679.24 / $679.24	Professional		$659.45	$679.24	$679.24
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 $404.98 / $417.13 / $417.13	Professional	TC	$404.98	$417.13	$417.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $44.37	Professional		$32.34	$32.34	$44.37
Providence Facility/Professional Facility Modifier Low / Median / High Price $50.01 / $89.50 / $197.47	Facility		$50.01	$89.50	$197.47
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $34.29 / $34.29 / $34.29	Facility	26	$34.29	$34.29	$34.29
Providence Facility/Professional Professional Modifier Low / Median / High Price $56.76 / $110.02 / $196.83	Professional		$56.76	$110.02	$196.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $32.17 / $55.02 / $118.05	Professional	26	$32.17	$55.02	$118.05
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $21.42 / $52.09 / $115.54	Professional	TC	$21.42	$52.09	$115.54
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $175.19 / $175.19 / $175.19	Professional		$175.19	$175.19	$175.19
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $103.62 / $103.62 / $103.62	Professional	26	$103.62	$103.62	$103.62
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $71.56 / $71.56 / $71.56	Professional	TC	$71.56	$71.56	$71.56
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $47.72 / $65.62 / $161.99	Professional		$47.72	$65.62	$161.99
United Facility/Professional Professional Modifier Low / Median / High Price $53.77 / $75.03 / $175.30	Professional		$53.77	$75.03	$175.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.11 / $38.72 / $90.60	Professional	26	$32.11	$38.72	$90.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.60 / $32.61 / $73.47	Professional	TC	$21.60	$32.61	$73.47