Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $137.36 / $522.50 / $1,400.03	Facility		$137.36	$522.50	$1,400.03
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.44 / $41.06 / $213.44	Facility	26	$33.44	$41.06	$213.44
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $117.14 / $411.23 / $791.45	Facility	TC	$117.14	$411.23	$791.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.01 / $152.41 / $639.00	Professional		$114.01	$152.41	$639.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.67 / $48.00 / $163.11	Professional	26	$31.67	$48.00	$163.11
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $44.10 / $59.82 / $328.05	Professional	52	$44.10	$59.82	$328.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.97 / $100.06 / $319.22	Professional	TC	$74.97	$100.06	$319.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $76.67 / $105.73 / $235.38	Professional		$76.67	$105.73	$235.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.74 / $35.88 / $70.37	Professional	26	$25.74	$35.88	$70.37
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $53.54 / $98.41 / $133.51	Professional	TC	$53.54	$98.41	$133.51
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $41.65 / $475.00 / $706.00	Facility		$41.65	$475.00	$706.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $121.28 / $168.34 / $334.76	Professional		$121.28	$168.34	$334.76
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.97 / $51.46 / $98.94	Professional	26	$38.97	$51.46	$98.94
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $82.29 / $118.67 / $232.25	Professional	TC	$82.29	$118.67	$232.25
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $59.40 / $147.38 / $773.64	Facility		$59.40	$147.38	$773.64
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $131.81 / $317.66	Professional		$100.00	$131.81	$317.66
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $32.10 / $42.20 / $100.00	Professional	26	$32.10	$42.20	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $70.06 / $93.09 / $219.54	Professional	TC	$70.06	$93.09	$219.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $151.10 / $331.19 / $681.32	Facility		$151.10	$331.19	$681.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.13 / $40.13 / $40.13	Facility	26	$40.13	$40.13	$40.13
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $82.40 / $82.40 / $82.40	Facility	TC	$82.40	$82.40	$82.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.91 / $155.03 / $334.58	Professional		$102.91	$155.03	$334.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.77 / $46.16 / $99.31	Professional	26	$30.77	$46.16	$99.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.23 / $111.86 / $232.61	Professional	TC	$70.23	$111.86	$232.61
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $80.72 / $138.44 / $186.89	Professional		$80.72	$138.44	$186.89
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.02 / $38.54 / $52.04	Professional	26	$25.02	$38.54	$52.04
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $55.70 / $99.89 / $134.85	Professional	TC	$55.70	$99.89	$134.85
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $139.93 / $139.93 / $139.93	Professional		$139.93	$139.93	$139.93
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $73.29 / $73.29 / $73.29	Professional	26	$73.29	$73.29	$73.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $106.93 / $140.04 / $264.29	Professional		$106.93	$140.04	$264.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.19 / $48.15 / $81.05	Professional	26	$34.19	$48.15	$81.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $79.91 / $117.23 / $196.01	Professional	TC	$79.91	$117.23	$196.01
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $245.42 / $514.16 / $570.62	Facility		$245.42	$514.16	$570.62
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $157.44 / $170.43	Facility	26	$100.00	$157.44	$170.43
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $148.82 / $331.53 / $400.24	Facility	TC	$148.82	$331.53	$400.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $704.47 / $704.47 / $902.70	Professional		$704.47	$704.47	$902.70
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $290.60 / $290.60 / $290.60	Professional	26	$290.60	$290.60	$290.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $483.33 / $483.33 / $621.90	Professional	TC	$483.33	$483.33	$621.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $81.90	Professional		$32.34	$32.34	$81.90
Providence Facility/Professional Facility Modifier Low / Median / High Price $113.93 / $160.76 / $279.38	Facility		$113.93	$160.76	$279.38
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $40.13 / $40.13 / $40.13	Facility	26	$40.13	$40.13	$40.13
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $82.40 / $82.40 / $82.40	Facility	TC	$82.40	$82.40	$82.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $103.23 / $172.24 / $321.32	Professional		$103.23	$172.24	$321.32
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $30.77 / $44.00 / $97.71	Professional	26	$30.77	$44.00	$97.71
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $71.33 / $108.39 / $232.09	Professional	TC	$71.33	$108.39	$232.09
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $377.55 / $377.55 / $377.55	Professional		$377.55	$377.55	$377.55
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $119.64 / $119.64 / $119.64	Professional	26	$119.64	$119.64	$119.64
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $257.89 / $257.89 / $257.89	Professional	TC	$257.89	$257.89	$257.89
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $111.95 / $153.93 / $196.83	Professional		$111.95	$153.93	$196.83
United Facility/Professional Facility Modifier Low / Median / High Price $114.39 / $178.30 / $866.25	Facility		$114.39	$178.30	$866.25
United Facility/Professional Professional Modifier Low / Median / High Price $95.49 / $116.44 / $339.84	Professional		$95.49	$116.44	$339.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.43 / $37.53 / $100.94	Professional	26	$26.43	$37.53	$100.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $68.03 / $78.03 / $239.77	Professional	TC	$68.03	$78.03	$239.77