Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.62 / $56.96 / $290.38	Facility	26	$46.62	$56.96	$290.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.88 / $247.65 / $896.36	Professional		$84.88	$247.65	$896.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.62 / $62.32 / $245.00	Professional	26	$45.62	$62.32	$245.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,994.90 / $1,994.90 / $1,994.90	Professional	50	$1,994.90	$1,994.90	$1,994.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $98.31 / $201.03 / $442.00	Professional	TC	$98.31	$201.03	$442.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.82 / $161.50 / $268.45	Professional		$93.82	$161.50	$268.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.79 / $46.72 / $95.24	Professional	26	$34.79	$46.72	$95.24
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $54.05 / $54.05 / $59.03	Professional	TC	$54.05	$54.05	$59.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $175.20 / $303.61 / $562.70	Professional		$175.20	$303.61	$562.70
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.46 / $70.09 / $136.22	Professional	26	$48.46	$70.09	$136.22
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $211.06 / $263.26 / $483.75	Professional	50	$211.06	$263.26	$483.75
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $121.25 / $233.41 / $419.61	Professional	TC	$121.25	$233.41	$419.61
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $134.09 / $205.52 / $509.89	Professional		$134.09	$205.52	$509.89
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.42 / $61.23 / $144.03	Professional	26	$44.42	$61.23	$144.03
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $145.75 / $367.47	Professional	TC	$100.00	$145.75	$367.47
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.29 / $249.50 / $494.00	Professional		$125.29	$249.50	$494.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.99 / $60.00 / $133.16	Professional	26	$28.99	$60.00	$133.16
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $231.80 / $231.80 / $264.70	Professional	50	$231.80	$231.80	$264.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.46 / $186.17 / $369.36	Professional	TC	$84.46	$186.17	$369.36
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $124.34 / $169.02 / $228.18	Professional		$124.34	$169.02	$228.18
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.33 / $52.29 / $70.59	Professional	26	$32.33	$52.29	$70.59
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $92.01 / $116.73 / $157.59	Professional	TC	$92.01	$116.73	$157.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $132.13 / $175.00 / $285.00	Professional		$132.13	$175.00	$285.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.25 / $62.75 / $109.55	Professional	26	$46.25	$62.75	$109.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $89.98 / $134.97 / $218.87	Professional	TC	$89.98	$134.97	$218.87
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $430.56 / $430.56 / $442.24	Facility	26	$430.56	$430.56	$442.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,378.78 / $1,420.14 / $1,420.14	Professional		$1,378.78	$1,420.14	$1,420.14
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $300.10 / $300.10 / $376.28	Professional	26	$300.10	$300.10	$376.28
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,332.00 / $1,332.00 / $1,332.00	Professional	TC	$1,332.00	$1,332.00	$1,332.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $101.49	Professional		$32.34	$32.34	$101.49
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Providence Facility/Professional Professional Modifier Low / Median / High Price $130.71 / $266.87 / $438.58	Professional		$130.71	$266.87	$438.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.81 / $60.00 / $128.52	Professional	26	$28.81	$60.00	$128.52
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $84.46 / $190.24 / $360.29	Professional	TC	$84.46	$190.24	$360.29
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $515.78 / $515.78 / $515.78	Professional		$515.78	$515.78	$515.78
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $162.91 / $162.91 / $162.91	Professional	26	$162.91	$162.91	$162.91
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $352.87 / $352.87 / $352.87	Professional	TC	$352.87	$352.87	$352.87
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $136.69 / $187.96 / $514.84	Professional		$136.69	$187.96	$514.84
United Facility/Professional Professional Modifier Low / Median / High Price $133.75 / $197.61 / $442.10	Professional		$133.75	$197.61	$442.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.96 / $56.38 / $133.25	Professional	26	$41.96	$56.38	$133.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.19 / $144.40 / $322.55	Professional	TC	$90.19	$144.40	$322.55