Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.29 / $78.83 / $262.89	Facility	26	$59.29	$78.83	$262.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.01 / $189.36 / $758.21	Professional		$97.01	$189.36	$758.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.06 / $65.20 / $252.00	Professional	26	$45.06	$65.20	$252.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $43.66 / $67.17 / $314.14	Professional	52	$43.66	$67.17	$314.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.69 / $126.14 / $237.92	Professional	TC	$48.69	$126.14	$237.92
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $86.82 / $95.26 / $177.75	Professional		$86.82	$95.26	$177.75
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.45 / $56.55 / $213.29	Professional	26	$37.45	$56.55	$213.29
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $20.35 / $20.35 / $21.71	Professional	52	$20.35	$20.35	$21.71
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.12 / $246.52 / $528.82	Professional		$112.12	$246.52	$528.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.70 / $83.25 / $211.76	Professional	26	$50.70	$83.25	$211.76
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $60.52 / $160.53 / $310.02	Professional	TC	$60.52	$160.53	$310.02
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $113.25 / $174.64 / $389.76	Professional		$113.25	$174.64	$389.76
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $39.64 / $55.01 / $129.85	Professional	26	$39.64	$55.01	$129.85
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $84.55 / $120.78 / $260.31	Professional	TC	$84.55	$120.78	$260.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.20 / $220.71 / $436.55	Professional		$123.20	$220.71	$436.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.89 / $82.43 / $160.32	Professional	26	$50.89	$82.43	$160.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.00 / $140.05 / $286.00	Professional	TC	$67.00	$140.05	$286.00
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $82.72 / $120.66 / $162.88	Professional		$82.72	$120.66	$162.88
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.22 / $48.31 / $65.22	Professional	26	$37.22	$48.31	$65.22
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.50 / $72.34 / $97.67	Professional	TC	$45.50	$72.34	$97.67
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $92.75 / $118.30 / $237.04	Professional		$92.75	$118.30	$237.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.13 / $48.82 / $90.82	Professional	26	$40.13	$48.82	$90.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $55.87 / $72.34 / $135.86	Professional	TC	$55.87	$72.34	$135.86
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $102.90 / $333.99 / $333.99	Facility	26	$102.90	$333.99	$333.99
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,000.00 / $3,000.00 / $3,000.00	Professional		$3,000.00	$3,000.00	$3,000.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $870.13 / $870.13 / $870.13	Professional	26	$870.13	$870.13	$870.13
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $870.13 / $870.13 / $870.13	Professional	TC	$870.13	$870.13	$870.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $157.97	Professional		$32.34	$32.34	$157.97
Providence Facility/Professional Professional Modifier Low / Median / High Price $123.74 / $218.74 / $359.53	Professional		$123.74	$218.74	$359.53
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $53.61 / $85.25 / $150.68	Professional	26	$53.61	$85.25	$150.68
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $75.44 / $143.16 / $262.33	Professional	TC	$75.44	$143.16	$262.33
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $389.82 / $389.82 / $389.82	Professional		$389.82	$389.82	$389.82
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $147.54 / $147.54 / $147.54	Professional	26	$147.54	$147.54	$147.54
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $242.27 / $242.27 / $242.27	Professional	TC	$242.27	$242.27	$242.27
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $97.57 / $134.16 / $491.66	Professional		$97.57	$134.16	$491.66
United Facility/Professional Professional Modifier Low / Median / High Price $92.40 / $162.86 / $353.72	Professional		$92.40	$162.86	$353.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.33 / $65.53 / $132.08	Professional	26	$37.33	$65.53	$132.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.56 / $103.26 / $248.70	Professional	TC	$56.56	$103.26	$248.70