Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $122.77 / $494.00 / $1,333.64	Facility		$122.77	$494.00	$1,333.64
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.50 / $22.29 / $136.65	Facility	26	$20.50	$22.29	$136.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $108.25 / $128.90 / $536.00	Professional		$108.25	$128.90	$536.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.50 / $22.82 / $89.98	Professional	26	$20.50	$22.82	$89.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.37 / $105.31 / $262.64	Professional	TC	$91.37	$105.31	$262.64
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.29 / $131.19 / $207.35	Professional		$95.29	$131.19	$207.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.67 / $16.89 / $39.22	Professional	26	$13.67	$16.89	$39.22
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $22.33 / $293.00 / $876.00	Facility		$22.33	$293.00	$876.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $124.09 / $181.29 / $353.81	Professional		$124.09	$181.29	$353.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.33 / $32.79 / $63.05	Professional	26	$22.33	$32.79	$63.05
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $101.98 / $146.80 / $290.76	Professional	TC	$101.98	$146.80	$290.76
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $59.90 / $151.69 / $1,005.48	Facility		$59.90	$151.69	$1,005.48
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $112.17 / $185.77 / $442.06	Professional		$112.17	$185.77	$442.06
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $22.47 / $28.52 / $76.81	Professional	26	$22.47	$28.52	$76.81
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $157.94 / $374.02	Professional	TC	$100.00	$157.94	$374.02
Cigna Facility/Professional Facility Modifier Low / Median / High Price $168.89 / $362.18 / $3,294.00	Facility		$168.89	$362.18	$3,294.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.06 / $27.06 / $27.06	Facility	26	$27.06	$27.06	$27.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.62 / $193.02 / $370.72	Professional		$123.62	$193.02	$370.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.56 / $30.36 / $66.00	Professional	26	$22.56	$30.36	$66.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $105.31 / $163.99 / $313.64	Professional	TC	$105.31	$163.99	$313.64
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $79.33 / $120.73 / $206.05	Professional		$79.33	$120.73	$206.05
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.90 / $18.11 / $33.40	Professional	26	$11.90	$18.11	$33.40
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $67.43 / $102.62 / $172.65	Professional	TC	$67.43	$102.62	$172.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $116.82 / $152.63 / $275.00	Professional		$116.82	$152.63	$275.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.26 / $30.93 / $52.58	Professional	26	$22.26	$30.93	$52.58
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $98.65 / $150.05 / $250.88	Professional	TC	$98.65	$150.05	$250.88
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $232.86 / $528.33 / $623.15	Facility		$232.86	$528.33	$623.15
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $53.90 / $104.46 / $111.06	Facility	26	$53.90	$104.46	$111.06
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $983.25 / $1,013.21 / $1,040.97	Professional		$983.25	$1,013.21	$1,040.97
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $217.94 / $217.94 / $217.94	Professional	26	$217.94	$217.94	$217.94
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $794.40 / $889.85 / $914.23	Professional	TC	$794.40	$889.85	$914.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $126.92	Professional		$32.34	$32.34	$126.92
Providence Facility/Professional Facility Modifier Low / Median / High Price $123.32 / $168.52 / $303.38	Facility		$123.32	$168.52	$303.38
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $27.06 / $27.06 / $27.06	Facility	26	$27.06	$27.06	$27.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $129.22 / $207.32 / $353.29	Professional		$129.22	$207.32	$353.29
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.35 / $30.07 / $63.16	Professional	26	$22.35	$30.07	$63.16
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $104.81 / $164.74 / $305.39	Professional	TC	$104.81	$164.74	$305.39
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $404.18 / $404.18 / $404.18	Professional		$404.18	$404.18	$404.18
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $78.30 / $78.30 / $78.30	Professional	26	$78.30	$78.30	$78.30
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $325.87 / $325.87 / $325.87	Professional	TC	$325.87	$325.87	$325.87
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $100.61 / $154.75 / $204.82	Professional		$100.61	$154.75	$204.82
United Facility/Professional Facility Modifier Low / Median / High Price $110.74 / $110.74 / $110.74	Facility		$110.74	$110.74	$110.74
United Facility/Professional Professional Modifier Low / Median / High Price $95.76 / $154.87 / $365.77	Professional		$95.76	$154.87	$365.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.98 / $25.92 / $61.28	Professional	26	$18.98	$25.92	$61.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $76.16 / $125.82 / $283.64	Professional	TC	$76.16	$125.82	$283.64