Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $250.14 / $496.15 / $1,101.78	Facility		$250.14	$496.15	$1,101.78
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.46 / $61.72 / $242.33	Facility	26	$55.46	$61.72	$242.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.57 / $225.03 / $896.25	Professional		$151.57	$225.03	$896.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.62 / $61.00 / $219.85	Professional	26	$41.62	$61.00	$219.85
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $232.76 / $232.76 / $239.76	Professional	52	$232.76	$232.76	$239.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.95 / $156.36 / $250.59	Professional	TC	$103.95	$156.36	$250.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $110.84 / $126.94 / $284.25	Professional		$110.84	$126.94	$284.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.80 / $47.94 / $72.72	Professional	26	$31.80	$47.94	$72.72
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $30.48 / $31.58 / $133.56	Professional	52	$30.48	$31.58	$133.56
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $101.10 / $164.76 / $167.86	Professional	TC	$101.10	$164.76	$167.86
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $60.87 / $570.00 / $5,140.00	Facility		$60.87	$570.00	$5,140.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $155.28 / $251.16 / $533.05	Professional		$155.28	$251.16	$533.05
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.41 / $70.08 / $136.25	Professional	26	$43.41	$70.08	$136.25
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $102.45 / $186.56 / $387.40	Professional	TC	$102.45	$186.56	$387.40
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $59.40 / $253.69 / $1,637.15	Facility		$59.40	$253.69	$1,637.15
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $118.30 / $177.83 / $428.04	Professional		$118.30	$177.83	$428.04
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.60 / $46.20 / $109.21	Professional	26	$33.60	$46.20	$109.21
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $92.83 / $129.93 / $312.76	Professional	TC	$92.83	$129.93	$312.76
Cigna Facility/Professional Facility Modifier Low / Median / High Price $163.79 / $200.46 / $587.45	Facility		$163.79	$200.46	$587.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $171.59 / $263.08 / $504.42	Professional		$171.59	$263.08	$504.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.81 / $69.23 / $137.60	Professional	26	$45.81	$69.23	$137.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $126.36 / $195.90 / $382.38	Professional	TC	$126.36	$195.90	$382.38
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $137.76 / $166.04 / $224.15	Professional		$137.76	$166.04	$224.15
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.80 / $42.74 / $57.70	Professional	26	$24.80	$42.74	$57.70
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $112.96 / $123.30 / $166.46	Professional	TC	$112.96	$123.30	$166.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.68 / $159.69 / $312.16	Professional		$125.68	$159.69	$312.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.59 / $43.18 / $80.34	Professional	26	$35.59	$43.18	$80.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $95.11 / $123.30 / $231.31	Professional	TC	$95.11	$123.30	$231.31
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $260.18 / $682.58 / $2,210.79	Facility		$260.18	$682.58	$2,210.79
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $91.76 / $174.10 / $188.81	Facility	26	$91.76	$174.10	$188.81
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,023.12 / $1,027.63 / $2,210.79	Professional		$1,023.12	$1,027.63	$2,210.79
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $261.30 / $269.14 / $308.02	Professional	26	$261.30	$269.14	$308.02
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $767.60 / $767.60 / $2,112.67	Professional	TC	$767.60	$767.60	$2,112.67
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $186.45	Professional		$32.34	$32.34	$186.45
Providence Facility/Professional Facility Modifier Low / Median / High Price $143.02 / $190.71 / $292.26	Facility		$143.02	$190.71	$292.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $175.87 / $287.29 / $446.78	Professional		$175.87	$287.29	$446.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $47.92 / $71.64 / $137.60	Professional	26	$47.92	$71.64	$137.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $127.48 / $202.73 / $382.38	Professional	TC	$127.48	$202.73	$382.38
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $556.12 / $556.12 / $556.12	Professional		$556.12	$556.12	$556.12
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $135.91 / $135.91 / $135.91	Professional	26	$135.91	$135.91	$135.91
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $420.19 / $420.19 / $420.19	Professional	TC	$420.19	$420.19	$420.19
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $134.28 / $179.09 / $234.19	Professional		$134.28	$179.09	$234.19
United Facility/Professional Facility Modifier Low / Median / High Price $156.19 / $156.19 / $156.19	Facility		$156.19	$156.19	$156.19
United Facility/Professional Professional Modifier Low / Median / High Price $131.04 / $205.23 / $481.38	Professional		$131.04	$205.23	$481.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.07 / $56.96 / $122.09	Professional	26	$34.07	$56.96	$122.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.50 / $150.49 / $384.08	Professional	TC	$97.50	$150.49	$384.08