Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $36.31 / $138.04	Facility	26	$25.70	$36.31	$138.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $64.57 / $275.42	Professional		$44.67	$64.57	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $30.90 / $83.18	Professional	26	$23.44	$30.90	$83.18
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $33.11 / $309.03 / $323.59	Professional	52	$33.11	$309.03	$323.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $25.70 / $131.83	Professional	TC	$18.20	$25.70	$131.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $44.67 / $95.50	Professional		$36.31	$44.67	$95.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $50.12 / $67.61	Professional	26	$26.92	$50.12	$67.61
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $10.72 / $24.55 / $25.70	Professional	TC	$10.72	$24.55	$25.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $112.20 / $186.21	Professional		$58.88	$112.20	$186.21
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $57.54 / $95.50	Professional	26	$33.11	$57.54	$95.50
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $54.95 / $89.13	Professional	TC	$26.92	$54.95	$89.13
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $85.11 / $154.88	Professional		$58.88	$85.11	$154.88
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $35.48 / $77.62	Professional	26	$28.18	$35.48	$77.62
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $33.11 / $72.44	Professional	TC	$24.55	$33.11	$72.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.61 / $30.90 / $43.65	Facility	26	$6.61	$30.90	$43.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $38.90 / $56.23	Professional		$38.90	$38.90	$56.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $25.12 / $25.12	Professional	26	$25.12	$25.12	$25.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $14.13 / $14.13	Professional	TC	$14.13	$14.13	$14.13
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $50.12 / $67.61	Professional		$47.86	$50.12	$67.61
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $31.62 / $42.66	Professional	26	$25.12	$31.62	$42.66
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $22.39 / $25.12	Professional	TC	$17.78	$22.39	$25.12
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $1,659.59 / $1,659.59	Professional		$1,659.59	$1,659.59	$1,659.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $48.98 / $83.18	Professional		$38.02	$48.98	$83.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $37.15 / $60.26	Professional	26	$28.18	$37.15	$60.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $14.79 / $19.05 / $33.88	Professional	TC	$14.79	$19.05	$33.88
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $181.97 / $181.97 / $181.97	Facility	26	$181.97	$181.97	$181.97
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $363.08 / $363.08	Professional		$74.13	$363.08	$363.08
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $181.97 / $229.09 / $229.09	Professional	26	$181.97	$229.09	$229.09
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	TC	$151.36	$151.36	$151.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $33.11 / $60.26	Professional		$26.30	$33.11	$60.26
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $6.61 / $30.90 / $43.65	Facility	26	$6.61	$30.90	$43.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $37.15 / $117.49	Professional		$37.15	$37.15	$117.49
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $25.70 / $25.70	Professional	26	$25.70	$25.70	$25.70
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $11.75 / $11.75 / $11.75	Professional	TC	$11.75	$11.75	$11.75
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $181.97 / $181.97	Professional		$181.97	$181.97	$181.97
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $97.72 / $97.72	Professional	26	$97.72	$97.72	$97.72
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $85.11 / $85.11	Professional	TC	$85.11	$85.11	$85.11
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $56.23 / $81.28	Professional		$40.74	$56.23	$81.28
United Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $61.66 / $117.49	Professional		$43.65	$61.66	$117.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $33.88 / $61.66	Professional	26	$23.99	$33.88	$61.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $27.54 / $54.95	Professional	TC	$19.95	$27.54	$54.95