Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $109.65 / $398.11	Professional		$93.33	$109.65	$398.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $79.43 / $154.88	Professional	26	$70.79	$79.43	$154.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $331.13 / $331.13 / $331.13	Professional	52	$331.13	$331.13	$331.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $28.84 / $51.29	Professional	TC	$18.20	$28.84	$51.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $100.00 / $125.89	Professional		$89.13	$100.00	$125.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $165.96 / $165.96	Professional	26	$165.96	$165.96	$165.96
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $72.44 / $72.44	Professional	TC	$72.44	$72.44	$72.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $147.91 / $380.19	Professional		$97.72	$147.91	$380.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $117.49 / $295.12	Professional	26	$77.62	$117.49	$295.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $32.36 / $91.20	Professional	TC	$18.20	$32.36	$91.20
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $104.71 / $162.18	Professional		$87.10	$104.71	$162.18
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $85.11 / $128.82	Professional	26	$70.79	$85.11	$128.82
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $19.95 / $32.36	Professional	TC	$15.49	$19.95	$32.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $87.10 / $123.03	Facility	26	$18.62	$87.10	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $120.23 / $288.40	Professional		$89.13	$120.23	$288.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $93.33 / $223.87	Professional	26	$67.61	$93.33	$223.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $29.51 / $91.20	Professional	TC	$17.78	$29.51	$91.20
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $123.03 / $154.88	Professional		$81.28	$123.03	$154.88
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $89.13 / $107.15	Professional	26	$64.57	$89.13	$107.15
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $26.92 / $48.98	Professional	TC	$18.20	$26.92	$48.98
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $114.82 / $190.55	Professional		$93.33	$114.82	$190.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $81.28 / $97.72	Professional	26	$69.18	$81.28	$97.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $36.31 / $40.74	Professional	TC	$28.18	$36.31	$40.74
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $489.78 / $489.78 / $489.78	Facility	26	$489.78	$489.78	$489.78
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $851.14 / $851.14	Professional		$707.95	$851.14	$851.14
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $489.78 / $602.56 / $602.56	Professional	26	$489.78	$602.56	$602.56
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $245.47 / $245.47	Professional	TC	$213.80	$245.47	$245.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $107.15 / $151.36	Professional		$41.69	$107.15	$151.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $123.03 / $288.40	Professional		$89.13	$123.03	$288.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $93.33 / $213.80	Professional	26	$67.61	$93.33	$213.80
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $29.51 / $74.13	Professional	TC	$18.20	$29.51	$74.13
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $354.81 / $354.81	Professional		$354.81	$354.81	$354.81
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $263.03 / $263.03 / $263.03	Professional	26	$263.03	$263.03	$263.03
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $93.33 / $93.33	Professional	TC	$93.33	$93.33	$93.33
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $120.23 / $144.54	Professional		$120.23	$120.23	$144.54
United Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $97.72 / $199.53	Professional		$79.43	$97.72	$199.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $75.86 / $144.54	Professional	26	$60.26	$75.86	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $23.44 / $52.48	Professional	TC	$16.22	$23.44	$52.48