Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $84.81 / $230.38 / $531.75	Facility		$84.81	$230.38	$531.75
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.34 / $31.64 / $187.60	Facility	26	$28.34	$31.64	$187.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.51 / $84.81 / $233.00	Professional		$46.51	$84.81	$233.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.33 / $34.78 / $104.45	Professional	26	$28.33	$34.78	$104.45
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $115.34 / $209.18 / $395.62	Professional	50	$115.34	$209.18	$395.62
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $20.18 / $39.68 / $167.43	Professional	52	$20.18	$39.68	$167.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.23 / $56.46 / $132.91	Professional	TC	$19.23	$56.46	$132.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $36.26 / $41.09 / $64.95	Professional		$36.26	$41.09	$64.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.62 / $25.62 / $127.80	Professional	26	$25.62	$25.62	$127.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $14.72 / $14.72 / $14.72	Professional	TC	$14.72	$14.72	$14.72
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $26.23 / $293.00 / $876.00	Facility		$26.23	$293.00	$876.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.01 / $91.75 / $183.21	Professional		$70.01	$91.75	$183.21
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.48 / $35.56 / $70.67	Professional	26	$26.48	$35.56	$70.67
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $74.80 / $102.91 / $130.18	Professional	50	$74.80	$102.91	$130.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $37.36 / $57.29 / $110.97	Professional	TC	$37.36	$57.29	$110.97
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $59.90 / $113.33 / $582.51	Facility		$59.90	$113.33	$582.51
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $64.14 / $84.38 / $202.22	Professional		$64.14	$84.38	$202.22
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.78 / $30.40 / $82.77	Professional	26	$23.78	$30.40	$82.77
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $40.36 / $54.43 / $121.57	Professional	TC	$40.36	$54.43	$121.57
Cigna Facility/Professional Facility Modifier Low / Median / High Price $52.57 / $52.57 / $52.57	Facility		$52.57	$52.57	$52.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.84 / $33.84 / $33.84	Facility	26	$33.84	$33.84	$33.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.22 / $103.06 / $221.24	Professional		$66.22	$103.06	$221.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.62 / $39.65 / $86.43	Professional	26	$28.62	$39.65	$86.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.49 / $65.13 / $123.97	Professional	TC	$26.49	$65.13	$123.97
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $58.31 / $67.14 / $80.56	Professional		$58.31	$67.14	$80.56
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.83 / $34.75 / $46.91	Professional	26	$22.83	$34.75	$46.91
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.55 / $31.79 / $53.17	Professional	TC	$23.55	$31.79	$53.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $46.23 / $60.26 / $109.55	Professional		$46.23	$60.26	$109.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.91 / $42.75 / $71.84	Professional	26	$29.91	$42.75	$71.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $19.25 / $28.23 / $46.30	Professional	TC	$19.25	$28.23	$46.30
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $100.79 / $267.77 / $267.77	Facility		$100.79	$267.77	$267.77
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $68.52 / $134.74 / $149.91	Facility	26	$68.52	$134.74	$149.91
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $459.15 / $472.92 / $472.92	Professional		$459.15	$472.92	$472.92
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $188.73 / $188.73 / $239.70	Professional	26	$188.73	$188.73	$239.70
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $313.58 / $323.00 / $323.00	Professional	TC	$313.58	$323.00	$323.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $50.94	Professional		$32.34	$32.34	$50.94
Providence Facility/Professional Facility Modifier Low / Median / High Price $51.07 / $79.53 / $136.00	Facility		$51.07	$79.53	$136.00
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $33.84 / $33.84 / $33.84	Facility	26	$33.84	$33.84	$33.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $64.43 / $106.00 / $181.52	Professional		$64.43	$106.00	$181.52
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.21 / $38.71 / $83.44	Professional	26	$28.21	$38.71	$83.44
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $29.46 / $65.73 / $131.28	Professional	TC	$29.46	$65.73	$131.28
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $207.75 / $207.75 / $207.75	Professional		$207.75	$207.75	$207.75
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $102.52 / $102.52 / $102.52	Professional	26	$102.52	$102.52	$102.52
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $105.23 / $105.23 / $105.23	Professional	TC	$105.23	$105.23	$105.23
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $47.15 / $64.83 / $114.14	Professional		$47.15	$64.83	$114.14
United Facility/Professional Professional Modifier Low / Median / High Price $50.82 / $77.80 / $187.08	Professional		$50.82	$77.80	$187.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.42 / $32.09 / $86.94	Professional	26	$22.42	$32.09	$86.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.88 / $44.20 / $103.95	Professional	TC	$22.88	$44.20	$103.95