Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.49 / $91.68 / $543.22	Facility	26	$87.49	$91.68	$543.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.00 / $438.26 / $1,093.97	Professional		$275.00	$438.26	$1,093.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.39 / $98.00 / $417.23	Professional	26	$82.39	$98.00	$417.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.16 / $350.77 / $761.34	Professional	TC	$187.16	$350.77	$761.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $135.29 / $270.58 / $592.73	Professional		$135.29	$270.58	$592.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $65.88 / $108.31 / $199.85	Professional	26	$65.88	$108.31	$199.85
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $343.90 / $540.75 / $1,053.54	Professional		$343.90	$540.75	$1,053.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $78.90 / $109.52 / $221.94	Professional	26	$78.90	$109.52	$221.94
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $399.36 / $506.16 / $650.88	Professional	50	$399.36	$506.16	$650.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $251.74 / $425.25 / $793.10	Professional	TC	$251.74	$425.25	$793.10
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $273.11 / $419.08 / $1,040.86	Professional		$273.11	$419.08	$1,040.86
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.87 / $113.83 / $275.22	Professional	26	$83.87	$113.83	$275.22
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $196.71 / $301.49 / $770.18	Professional	TC	$196.71	$301.49	$770.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.96 / $101.96 / $101.96	Facility	26	$101.96	$101.96	$101.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $255.50 / $503.44 / $1,062.99	Professional		$255.50	$503.44	$1,062.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.31 / $105.86 / $252.54	Professional	26	$54.31	$105.86	$252.54
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $458.57 / $458.57 / $523.66	Professional	50	$458.57	$458.57	$523.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $207.03 / $396.07 / $813.07	Professional	TC	$207.03	$396.07	$813.07
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $316.02 / $350.10 / $472.64	Professional		$316.02	$350.10	$472.64
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.01 / $98.60 / $133.11	Professional	26	$79.01	$98.60	$133.11
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $237.02 / $251.50 / $339.53	Professional	TC	$237.02	$251.50	$339.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $312.83 / $423.23 / $754.00	Professional		$312.83	$423.23	$754.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.46 / $118.32 / $187.25	Professional	26	$87.46	$118.32	$187.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $252.80 / $379.20 / $614.86	Professional	TC	$252.80	$379.20	$614.86
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $816.32 / $816.32 / $833.76	Facility	26	$816.32	$816.32	$833.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,878.66 / $2,965.02 / $2,965.02	Professional		$2,878.66	$2,965.02	$2,965.02
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $561.99 / $561.99 / $717.75	Professional	26	$561.99	$561.99	$717.75
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,400.63 / $2,472.65 / $2,472.65	Professional	TC	$2,400.63	$2,472.65	$2,472.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $227.16	Professional		$32.34	$32.34	$227.16
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $101.96 / $101.96 / $101.96	Facility	26	$101.96	$101.96	$101.96
Providence Facility/Professional Professional Modifier Low / Median / High Price $271.26 / $596.61 / $995.33	Professional		$271.26	$596.61	$995.33
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.21 / $102.39 / $248.70	Professional	26	$51.21	$102.39	$248.70
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $202.73 / $389.79 / $791.34	Professional	TC	$202.73	$389.79	$791.34
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,185.95 / $1,185.95 / $1,185.95	Professional		$1,185.95	$1,185.95	$1,185.95
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $305.23 / $305.23 / $305.23	Professional	26	$305.23	$305.23	$305.23
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $880.71 / $880.71 / $880.71	Professional	TC	$880.71	$880.71	$880.71
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $283.13 / $389.30 / $537.25	Professional		$283.13	$389.30	$537.25
United Facility/Professional Professional Modifier Low / Median / High Price $306.77 / $401.01 / $910.27	Professional		$306.77	$401.01	$910.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.40 / $100.47 / $228.29	Professional	26	$74.40	$100.47	$228.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $225.17 / $330.30 / $708.88	Professional	TC	$225.17	$330.30	$708.88