Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.64 / $88.10 / $299.00	Professional		$56.64	$88.10	$299.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $81.93 / $81.93 / $81.93	Professional	25	$81.93	$81.93	$81.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.69 / $28.98 / $111.49	Professional	26	$23.69	$28.98	$111.49
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $389.65 / $389.65 / $389.65	Professional	50	$389.65	$389.65	$389.65
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.89 / $35.25 / $234.75	Professional	52	$24.89	$35.25	$234.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.78 / $56.11 / $91.08	Professional	TC	$30.78	$56.11	$91.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.66 / $59.68 / $334.56	Professional		$52.66	$59.68	$334.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.31 / $27.89 / $50.94	Professional	26	$22.31	$27.89	$50.94
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $29.04 / $29.04 / $41.58	Professional	TC	$29.04	$29.04	$41.58
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.91 / $78.06 / $185.86	Professional		$60.91	$78.06	$185.86
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.49 / $30.33 / $92.32	Professional	26	$23.49	$30.33	$92.32
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.07 / $49.57 / $116.98	Professional	TC	$31.07	$49.57	$116.98
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $186.11 / $420.75 / $509.61	Facility		$186.11	$420.75	$509.61
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $48.90 / $69.86 / $98.09	Professional		$48.90	$69.86	$98.09
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.61 / $23.73 / $31.99	Professional	26	$16.61	$23.73	$31.99
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $32.29 / $46.13 / $66.22	Professional	TC	$32.29	$46.13	$66.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.13 / $96.83 / $273.45	Professional		$58.13	$96.83	$273.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.26 / $35.08 / $111.40	Professional	26	$24.26	$35.08	$111.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.79 / $62.29 / $160.35	Professional	TC	$32.79	$62.29	$160.35
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $29.29 / $45.77 / $88.85	Professional		$29.29	$45.77	$88.85
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.85 / $30.59 / $36.71	Professional	26	$22.85	$30.59	$36.71
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $6.44 / $10.07 / $55.19	Professional	TC	$6.44	$10.07	$55.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $58.68 / $70.20 / $122.87	Professional		$58.68	$70.20	$122.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.63 / $27.53 / $38.24	Professional	26	$24.63	$27.53	$38.24
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.85 / $45.15 / $61.18	Professional	TC	$36.85	$45.15	$61.18
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $129.86 / $286.08 / $333.50	Facility		$129.86	$286.08	$333.50
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $61.29 / $84.57 / $152.15	Facility	26	$61.29	$84.57	$152.15
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $396.63 / $403.38 / $524.78	Professional		$396.63	$403.38	$524.78
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $167.21 / $167.21 / $212.40	Professional	26	$167.21	$167.21	$212.40
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $257.11 / $264.83 / $312.38	Professional	TC	$257.11	$264.83	$312.38
Providence Facility/Professional Facility Modifier Low / Median / High Price $53.36 / $77.50 / $113.12	Facility		$53.36	$77.50	$113.12
Providence Facility/Professional Professional Modifier Low / Median / High Price $58.33 / $96.79 / $198.11	Professional		$58.33	$96.79	$198.11
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.25 / $33.59 / $83.32	Professional	26	$23.25	$33.59	$83.32
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $32.28 / $60.61 / $140.72	Professional	TC	$32.28	$60.61	$140.72
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $210.36 / $210.36 / $210.36	Professional		$210.36	$210.36	$210.36
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $90.70 / $90.70 / $90.70	Professional	26	$90.70	$90.70	$90.70
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $119.65 / $119.65 / $119.65	Professional	TC	$119.65	$119.65	$119.65
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $73.48 / $89.82 / $89.82	Professional		$73.48	$89.82	$89.82
United Facility/Professional Professional Modifier Low / Median / High Price $48.06 / $61.95 / $165.83	Professional		$48.06	$61.95	$165.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $24.96 / $67.37	Professional	26	$19.50	$24.96	$67.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.00 / $37.00 / $85.30	Professional	TC	$27.00	$37.00	$85.30