Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $426.58 / $977.24	Facility		$91.20	$426.58	$977.24
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.41 / $10.00 / $24.55	Facility	26	$7.41	$10.00	$24.55
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $32.36 / $177.83 / $588.84	Facility	TC	$32.36	$177.83	$588.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $13.49 / $45.71 / $162.18	Professional		$13.49	$45.71	$162.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $16.98 / $52.48	Professional	26	$7.76	$16.98	$52.48
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $18.62 / $91.20 / $229.09	Professional	50	$18.62	$91.20	$229.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $44.67 / $131.83	Professional	TC	$21.88	$44.67	$131.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $39.81 / $70.79	Professional		$28.84	$39.81	$70.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $12.02 / $20.42	Professional	26	$7.41	$12.02	$20.42
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $42.66 / $53.70 / $245.47	Professional	50	$42.66	$53.70	$245.47
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $37.15 / $54.95	Professional	TC	$23.44	$37.15	$54.95
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $9.55 / $10.72 / $204.17	Facility		$9.55	$10.72	$204.17
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $42.66 / $85.11	Professional		$31.62	$42.66	$85.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $12.30 / $23.99	Professional	26	$9.12	$12.30	$23.99
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $40.74 / $52.48 / $79.43	Professional	50	$40.74	$52.48	$79.43
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $30.90 / $63.10	Professional	TC	$22.91	$30.90	$63.10
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $102.33 / $245.47	Facility		$56.23	$102.33	$245.47
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $46.77 / $93.33	Professional		$34.67	$46.77	$93.33
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $12.02 / $22.39	Professional	26	$9.12	$12.02	$22.39
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $34.67 / $70.79	Professional	TC	$24.55	$34.67	$70.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $199.53 / $524.81	Facility		$58.88	$199.53	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.04 / $9.55 / $13.49	Facility	26	$2.04	$9.55	$13.49
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $6.76 / $31.62 / $44.67	Facility	TC	$6.76	$31.62	$44.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $42.66 / $85.11	Professional		$28.84	$42.66	$85.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $10.72 / $21.38	Professional	26	$7.41	$10.72	$21.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $30.90 / $64.57	Professional	TC	$20.89	$30.90	$64.57
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $51.29 / $69.18	Professional		$25.12	$51.29	$69.18
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $10.23 / $13.80	Professional	26	$6.76	$10.23	$13.80
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $40.74 / $54.95	Professional	TC	$18.20	$40.74	$54.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $47.86 / $81.28	Professional		$37.15	$47.86	$81.28
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $11.75 / $19.05	Professional	26	$8.71	$11.75	$19.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $44.67 / $77.62	Professional	TC	$33.88	$44.67	$77.62
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $363.08 / $363.08	Facility		$234.42	$363.08	$363.08
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $181.97 / $181.97 / $181.97	Facility	TC	$181.97	$181.97	$181.97
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $316.23 / $316.23	Professional		$53.70	$316.23	$316.23
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $67.61 / $67.61	Professional	26	$67.61	$67.61	$67.61
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $245.47 / $245.47	Professional	TC	$181.97	$245.47	$245.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $10.00 / $32.36 / $41.69	Professional		$10.00	$32.36	$41.69
Providence Facility/Professional Facility Modifier Low / Median / High Price $31.62 / $48.98 / $93.33	Facility		$31.62	$48.98	$93.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.04 / $9.55 / $13.49	Facility	26	$2.04	$9.55	$13.49
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $6.76 / $31.62 / $44.67	Facility	TC	$6.76	$31.62	$44.67
Providence Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $43.65 / $91.20	Professional		$28.84	$43.65	$91.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $10.23 / $19.95	Professional	26	$7.41	$10.23	$19.95
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $29.51 / $61.66	Professional	TC	$20.42	$29.51	$61.66
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $114.82 / $114.82	Professional		$114.82	$114.82	$114.82
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $28.84 / $28.84	Professional	26	$28.84	$28.84	$28.84
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $87.10 / $87.10	Professional	TC	$87.10	$87.10	$87.10
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $46.77 / $61.66	Professional		$38.02	$46.77	$61.66
United Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $138.04 / $218.78	Facility		$30.20	$138.04	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $35.48 / $75.86	Professional		$22.91	$35.48	$75.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $9.12 / $18.20	Professional	26	$6.61	$9.12	$18.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $26.30 / $57.54	Professional	TC	$16.60	$26.30	$57.54