Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $169.82 / $389.05	Facility	26	$100.00	$169.82	$389.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $537.03 / $1,862.09	Professional		$186.21	$537.03	$1,862.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $154.88 / $501.19	Professional	26	$66.07	$154.88	$501.19
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $707.95 / $707.95 / $2,137.96	Professional	50	$707.95	$707.95	$2,137.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $354.81 / $776.25	Professional	TC	$190.55	$354.81	$776.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $251.19 / $436.52	Professional		$165.96	$251.19	$436.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $125.89 / $147.91	Professional	26	$48.98	$125.89	$147.91
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $223.87 / $354.81	Professional	TC	$223.87	$223.87	$354.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $616.60 / $1,000.00	Professional		$371.54	$616.60	$1,000.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $81.28 / $177.83	Professional	26	$58.88	$81.28	$177.83
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $346.74 / $446.68 / $870.96	Professional	50	$346.74	$446.68	$870.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $537.03 / $831.76	Professional	TC	$288.40	$537.03	$831.76
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $575.44 / $1,071.52	Professional		$398.11	$575.44	$1,071.52
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $107.15 / $194.98	Professional	26	$77.62	$107.15	$194.98
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $467.74 / $870.96	Professional	TC	$323.59	$467.74	$870.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $72.44 / $104.71	Facility	26	$15.49	$72.44	$104.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $478.63 / $870.96	Professional		$223.87	$478.63	$870.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $81.28 / $158.49	Professional	26	$45.71	$81.28	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $371.54 / $724.44	Professional	TC	$165.96	$371.54	$724.44
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $295.12 / $398.11	Professional		$218.78	$295.12	$398.11
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $70.79 / $95.50	Professional	26	$37.15	$70.79	$95.50
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $223.87 / $302.00	Professional	TC	$181.97	$223.87	$302.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $295.12 / $562.34	Professional		$218.78	$295.12	$562.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $85.11 / $151.36	Professional	26	$64.57	$85.11	$151.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $257.04 / $436.52	Professional	TC	$190.55	$257.04	$436.52
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $588.84 / $588.84 / $588.84	Facility	26	$588.84	$588.84	$588.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,884.03 / $2,884.03 / $2,884.03	Professional		$2,884.03	$2,884.03	$2,884.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $537.03 / $537.03 / $537.03	Professional	26	$537.03	$537.03	$537.03
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,511.89 / $2,511.89 / $2,511.89	Professional	TC	$2,511.89	$2,511.89	$2,511.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $75.86 / $316.23	Professional		$32.36	$75.86	$316.23
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $72.44 / $104.71	Facility	26	$15.49	$72.44	$104.71
Providence Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $478.63 / $794.33	Professional		$229.09	$478.63	$794.33
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $75.86 / $144.54	Professional	26	$38.90	$75.86	$144.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $371.54 / $707.95	Professional	TC	$165.96	$371.54	$707.95
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $851.14 / $851.14	Professional		$851.14	$851.14	$851.14
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $218.78 / $218.78 / $218.78	Professional	26	$218.78	$218.78	$218.78
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $645.65 / $645.65 / $645.65	Professional	TC	$645.65	$645.65	$645.65
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $288.40 / $371.54	Professional		$218.78	$288.40	$371.54
United Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $371.54 / $741.31	Professional		$223.87	$371.54	$741.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $64.57 / $138.04	Professional	26	$50.12	$64.57	$138.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $281.84 / $602.56	Professional	TC	$162.18	$281.84	$602.56