Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $33.88 / $316.23 / $891.25	Facility		$33.88	$316.23	$891.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.13 / $10.96 / $57.54	Facility	26	$8.13	$10.96	$57.54
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $15.14 / $81.28 / $467.74	Facility	TC	$15.14	$81.28	$467.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $33.88 / $109.65	Professional		$17.78	$33.88	$109.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $11.22 / $40.74	Professional	26	$7.94	$11.22	$40.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $18.20 / $64.57	Professional	TC	$10.00	$18.20	$64.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $27.54 / $57.54	Professional		$20.42	$27.54	$57.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $12.59 / $22.91	Professional	26	$7.59	$12.59	$22.91
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $11.75 / $16.22 / $18.20	Professional	TC	$11.75	$16.22	$18.20
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $12.30 / $13.49 / $134.90	Facility		$12.30	$13.49	$134.90
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $42.66 / $74.13	Professional		$26.30	$42.66	$74.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $18.62 / $28.84	Professional	26	$11.22	$18.62	$28.84
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $23.99 / $44.67	Professional	TC	$15.85	$23.99	$44.67
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $89.13 / $199.53	Facility		$36.31	$89.13	$199.53
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $29.51 / $61.66	Professional		$20.89	$29.51	$61.66
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $13.49 / $25.12	Professional	26	$9.55	$13.49	$25.12
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $11.48 / $16.60 / $36.31	Professional	TC	$11.48	$16.60	$36.31
Cigna Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $199.53 / $524.81	Facility		$35.48	$199.53	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.14 / $10.00 / $14.13	Facility	26	$2.14	$10.00	$14.13
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $4.07 / $19.05 / $26.92	Facility	TC	$4.07	$19.05	$26.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $27.54 / $56.23	Professional		$19.95	$27.54	$56.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $11.48 / $22.39	Professional	26	$7.59	$11.48	$22.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.96 / $16.22 / $37.15	Professional	TC	$10.96	$16.22	$37.15
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $33.11 / $44.67	Professional		$17.78	$33.11	$44.67
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $9.55 / $12.88	Professional	26	$7.94	$9.55	$12.88
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $9.77 / $23.44 / $31.62	Professional	TC	$9.77	$23.44	$31.62
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $18.62 / $46.77	Professional	26	$7.76	$18.62	$46.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $31.62 / $53.70	Professional		$24.55	$31.62	$53.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $10.96 / $17.78	Professional	26	$8.32	$10.96	$17.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $25.70 / $44.67	Professional	TC	$19.50	$25.70	$44.67
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $165.96 / $363.08 / $363.08	Facility		$165.96	$363.08	$363.08
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $70.79 / $70.79	Facility	26	$70.79	$70.79	$70.79
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $109.65 / $109.65 / $109.65	Facility	TC	$109.65	$109.65	$109.65
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $218.78 / $218.78	Professional		$33.11	$218.78	$218.78
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $70.79 / $70.79	Professional	26	$54.95	$70.79	$70.79
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $147.91 / $147.91	Professional	TC	$109.65	$147.91	$147.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $10.47 / $29.51 / $33.11	Professional		$10.47	$29.51	$33.11
Providence Facility/Professional Facility Modifier Low / Median / High Price $20.89 / $33.88 / $77.62	Facility		$20.89	$33.88	$77.62
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.14 / $10.00 / $14.13	Facility	26	$2.14	$10.00	$14.13
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $4.07 / $19.05 / $26.92	Facility	TC	$4.07	$19.05	$26.92
Providence Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $28.84 / $64.57	Professional		$19.95	$28.84	$64.57
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $10.96 / $20.89	Professional	26	$7.59	$10.96	$20.89
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $10.96 / $15.49 / $33.88	Professional	TC	$10.96	$15.49	$33.88
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $85.11 / $85.11	Professional		$85.11	$85.11	$85.11
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $29.51 / $29.51	Professional	26	$29.51	$29.51	$29.51
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $54.95 / $54.95	Professional	TC	$54.95	$54.95	$54.95
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $26.92 / $31.62	Professional		$17.78	$26.92	$31.62
United Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $144.54 / $218.78	Facility		$138.04	$144.54	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $25.70 / $53.70	Professional		$15.85	$25.70	$53.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $9.33 / $19.05	Professional	26	$7.24	$9.33	$19.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $8.51 / $16.60 / $35.48	Professional	TC	$8.51	$16.60	$35.48