Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.36 / $37.36 / $6,906.48	Facility		$37.36	$37.36	$6,906.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.22 / $95.83 / $600.00	Professional		$61.22	$95.83	$600.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.35 / $70.43 / $516.60	Professional	26	$19.35	$70.43	$516.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.00 / $57.83 / $568.00	Professional	TC	$41.00	$57.83	$568.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $46.72 / $52.83 / $255.00	Professional		$46.72	$52.83	$255.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.24 / $48.27 / $127.50	Professional	26	$13.24	$48.27	$127.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $33.58 / $134.24 / $345.00	Professional	TC	$33.58	$134.24	$345.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $90.21 / $116.38 / $234.31	Professional		$90.21	$116.38	$234.31
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.78 / $34.54 / $69.62	Professional	26	$26.78	$34.54	$69.62
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.43 / $81.81 / $164.74	Professional	TC	$63.43	$81.81	$164.74
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $56.90 / $76.95 / $185.97	Professional		$56.90	$76.95	$185.97
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $17.64 / $23.86 / $66.98	Professional	26	$17.64	$23.86	$66.98
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $39.26 / $53.10 / $128.32	Professional	TC	$39.26	$53.10	$128.32
Cigna Facility/Professional Facility Modifier Low / Median / High Price $159.88 / $159.88 / $159.88	Facility		$159.88	$159.88	$159.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.02 / $59.60 / $178.81	Professional		$36.02	$59.60	$178.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.31 / $16.39 / $51.82	Professional	26	$11.31	$16.39	$51.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.71 / $42.37 / $127.11	Professional	TC	$24.71	$42.37	$127.11
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $60.62 / $126.34 / $170.56	Professional		$60.62	$126.34	$170.56
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.79 / $31.33 / $42.30	Professional	26	$18.79	$31.33	$42.30
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.83 / $95.01 / $128.26	Professional	TC	$41.83	$95.01	$128.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.83 / $117.62 / $195.83	Professional		$97.83	$117.62	$195.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.06 / $37.60 / $47.01	Professional	26	$25.06	$37.60	$47.01
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $70.17 / $113.43 / $142.52	Professional	TC	$70.17	$113.43	$142.52
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $212.88 / $437.49 / $516.33	Facility		$212.88	$437.49	$516.33
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $71.22 / $124.11 / $136.56	Facility	26	$71.22	$124.11	$136.56
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $149.77 / $313.37 / $379.76	Facility	TC	$149.77	$313.37	$379.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $559.76 / $559.76 / $804.98	Professional		$559.76	$559.76	$804.98
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $173.52 / $173.52 / $219.45	Professional	26	$173.52	$173.52	$219.45
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $386.24 / $386.24 / $585.53	Professional	TC	$386.24	$386.24	$585.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.42 / $64.19 / $96.61	Professional		$32.42	$64.19	$96.61
Providence Facility/Professional Facility Modifier Low / Median / High Price $68.98 / $129.08 / $172.46	Facility		$68.98	$129.08	$172.46
Providence Facility/Professional Professional Modifier Low / Median / High Price $38.28 / $91.88 / $256.30	Professional		$38.28	$91.88	$256.30
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $17.23 / $64.18	Professional	26	$11.75	$17.23	$64.18
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $25.50 / $43.36 / $139.63	Professional	TC	$25.50	$43.36	$139.63
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $352.58 / $352.58 / $352.58	Professional		$352.58	$352.58	$352.58
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $108.15 / $108.15 / $108.15	Professional	26	$108.15	$108.15	$108.15
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $244.43 / $244.43 / $244.43	Professional	TC	$244.43	$244.43	$244.43
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $102.20 / $102.20 / $140.53	Professional		$102.20	$102.20	$140.53
United Facility/Professional Professional Modifier Low / Median / High Price $41.81 / $59.81 / $241.32	Professional		$41.81	$59.81	$241.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $17.93 / $63.64	Professional	26	$13.49	$17.93	$63.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.11 / $41.47 / $150.94	Professional	TC	$29.11	$41.47	$150.94