Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $139.19 / $166.05 / $680.00	Facility		$139.19	$166.05	$680.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.73 / $18.50 / $111.05	Facility	26	$16.73	$18.50	$111.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.86 / $125.38 / $187.85	Professional		$61.86	$125.38	$187.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.95 / $18.50 / $49.10	Professional	26	$15.95	$18.50	$49.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.18 / $109.43 / $165.78	Professional	TC	$44.18	$109.43	$165.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $59.52 / $63.26 / $63.95	Professional		$59.52	$63.26	$63.95
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $18.25 / $293.00 / $876.00	Facility		$18.25	$293.00	$876.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.48 / $124.29 / $224.44	Professional		$67.48	$124.29	$224.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.43 / $23.67 / $65.61	Professional	26	$17.43	$23.67	$65.61
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $24.10 / $101.49 / $167.80	Professional	TC	$24.10	$101.49	$167.80
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $59.40 / $108.70 / $495.29	Facility		$59.40	$108.70	$495.29
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $86.10 / $116.73 / $258.45	Professional		$86.10	$116.73	$258.45
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.07 / $16.62 / $44.18	Professional	26	$12.07	$16.62	$44.18
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $71.06 / $100.00 / $215.67	Professional	TC	$71.06	$100.00	$215.67
Cigna Facility/Professional Facility Modifier Low / Median / High Price $310.38 / $386.04 / $1,180.43	Facility		$310.38	$386.04	$1,180.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.44 / $135.79 / $307.52	Professional		$74.44	$135.79	$307.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.29 / $23.56 / $53.35	Professional	26	$18.29	$23.56	$53.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $52.98 / $112.76 / $246.00	Professional	TC	$52.98	$112.76	$246.00
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $34.44 / $43.68 / $116.78	Professional		$34.44	$43.68	$116.78
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.72 / $27.21 / $32.65	Professional	26	$20.72	$27.21	$32.65
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $7.23 / $9.17 / $88.80	Professional	TC	$7.23	$9.17	$88.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $65.04 / $82.18 / $156.32	Professional		$65.04	$82.18	$156.32
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.07 / $20.94 / $37.40	Professional	26	$17.07	$20.94	$37.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $50.74 / $65.78 / $118.73	Professional	TC	$50.74	$65.78	$118.73
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $133.16 / $349.02 / $353.50	Facility		$133.16	$349.02	$353.50
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $42.01 / $100.00 / $134.26	Facility	26	$42.01	$100.00	$134.26
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $611.90 / $803.55 / $803.55	Professional		$611.90	$803.55	$803.55
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $416.07 / $416.07 / $416.07	Professional	26	$416.07	$416.07	$416.07
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $567.25 / $578.59 / $578.59	Professional	TC	$567.25	$578.59	$578.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.79 / $32.34 / $95.88	Professional		$25.79	$32.34	$95.88
Providence Facility/Professional Facility Modifier Low / Median / High Price $66.98 / $101.13 / $180.96	Facility		$66.98	$101.13	$180.96
Providence Facility/Professional Professional Modifier Low / Median / High Price $77.83 / $140.53 / $243.24	Professional		$77.83	$140.53	$243.24
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $18.32 / $23.75 / $50.19	Professional	26	$18.32	$23.75	$50.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $55.50 / $113.25 / $246.00	Professional	TC	$55.50	$113.25	$246.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $223.13 / $223.13 / $223.13	Professional		$223.13	$223.13	$223.13
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $61.40 / $61.40 / $61.40	Professional	26	$61.40	$61.40	$61.40
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $161.72 / $161.72 / $161.72	Professional	TC	$161.72	$161.72	$161.72
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $43.68 / $71.14 / $96.21	Professional		$43.68	$71.14	$96.21
United Facility/Professional Facility Modifier Low / Median / High Price $77.33 / $77.33 / $77.33	Facility		$77.33	$77.33	$77.33
United Facility/Professional Professional Modifier Low / Median / High Price $54.52 / $98.82 / $224.85	Professional		$54.52	$98.82	$224.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.84 / $20.05 / $46.81	Professional	26	$14.84	$20.05	$46.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.15 / $81.37 / $179.19	Professional	TC	$39.15	$81.37	$179.19