Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $435.04 / $435.04 / $435.04	Facility		$435.04	$435.04	$435.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.96 / $88.99 / $228.71	Professional		$52.96	$88.99	$228.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.75 / $48.95 / $157.25	Professional	26	$21.75	$48.95	$157.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.30 / $47.77 / $209.66	Professional	TC	$30.30	$47.77	$209.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.78 / $33.15 / $121.26	Professional		$32.78	$33.15	$121.26
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.14 / $46.98 / $60.28	Professional	26	$13.14	$46.98	$60.28
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $20.02 / $20.02 / $20.02	Professional	TC	$20.02	$20.02	$20.02
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.25 / $150.91 / $294.49	Professional		$77.25	$150.91	$294.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.18 / $79.50 / $138.35	Professional	26	$31.18	$79.50	$138.35
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $42.39 / $67.48 / $141.50	Professional	TC	$42.39	$67.48	$141.50
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $93.16 / $130.59 / $302.72	Professional		$93.16	$130.59	$302.72
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $49.42 / $70.28 / $160.88	Professional	26	$49.42	$70.28	$160.88
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $43.74 / $60.32 / $138.72	Professional	TC	$43.74	$60.32	$138.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $94.68 / $94.68 / $94.68	Facility		$94.68	$94.68	$94.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.33 / $57.72 / $190.03	Professional		$34.33	$57.72	$190.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.23 / $29.69 / $90.23	Professional	26	$14.23	$29.69	$90.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.87 / $28.29 / $104.43	Professional	TC	$19.87	$28.29	$104.43
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $60.92 / $86.55 / $116.84	Professional		$60.92	$86.55	$116.84
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.15 / $30.41 / $41.05	Professional	26	$23.15	$30.41	$41.05
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.77 / $56.14 / $75.79	Professional	TC	$37.77	$56.14	$75.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $67.79 / $82.34 / $131.81	Professional		$67.79	$82.34	$131.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.33 / $36.49 / $45.63	Professional	26	$24.33	$36.49	$45.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $41.48 / $67.13 / $84.21	Professional	TC	$41.48	$67.13	$84.21
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $140.87 / $379.47 / $379.47	Facility		$140.87	$379.47	$379.47
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $63.72 / $234.18 / $234.18	Facility	26	$63.72	$234.18	$234.18
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $130.88 / $186.22 / $224.87	Facility	TC	$130.88	$186.22	$224.87
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $641.00 / $645.55 / $645.55	Professional		$641.00	$645.55	$645.55
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $513.00 / $513.00 / $513.00	Professional	26	$513.00	$513.00	$513.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $312.17 / $321.52 / $349.13	Professional	TC	$312.17	$321.52	$349.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $31.68 / $43.76 / $75.44	Professional		$31.68	$43.76	$75.44
Providence Facility/Professional Facility Modifier Low / Median / High Price $75.31 / $113.75 / $190.90	Facility		$75.31	$113.75	$190.90
Providence Facility/Professional Professional Modifier Low / Median / High Price $36.45 / $118.20 / $196.42	Professional		$36.45	$118.20	$196.42
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.05 / $30.84 / $90.23	Professional	26	$15.05	$30.84	$90.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $20.92 / $32.69 / $110.12	Professional	TC	$20.92	$32.69	$110.12
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $255.00 / $255.00 / $255.00	Professional		$255.00	$255.00	$255.00
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $105.42 / $105.42 / $105.42	Professional	26	$105.42	$105.42	$105.42
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $149.57 / $149.57 / $149.57	Professional	TC	$149.57	$149.57	$149.57
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $70.00 / $70.00 / $96.25	Professional		$70.00	$70.00	$96.25
United Facility/Professional Professional Modifier Low / Median / High Price $41.14 / $61.71 / $173.95	Professional		$41.14	$61.71	$173.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.32 / $28.87 / $76.54	Professional	26	$17.32	$28.87	$76.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.82 / $30.47 / $114.22	Professional	TC	$23.82	$30.47	$114.22