Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $59.32 / $390.27 / $914.00	Facility		$59.32	$390.27	$914.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.14 / $13.07 / $63.45	Facility	26	$10.14	$13.07	$63.45
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.11 / $285.97 / $461.54	Facility	TC	$28.11	$285.97	$461.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.66 / $40.46 / $144.00	Professional		$27.66	$40.46	$144.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.71 / $16.01 / $53.00	Professional	26	$9.71	$16.01	$53.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.92 / $26.87 / $95.00	Professional	TC	$17.92	$26.87	$95.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.18 / $37.60 / $74.33	Professional		$25.18	$37.60	$74.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.72 / $11.70 / $23.50	Professional	26	$7.72	$11.70	$23.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.94 / $29.56 / $48.35	Professional	TC	$23.94	$29.56	$48.35
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $14.54 / $172.42 / $876.00	Facility		$14.54	$172.42	$876.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $31.75 / $58.59 / $104.40	Professional		$31.75	$58.59	$104.40
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.84 / $20.07 / $34.68	Professional	26	$10.84	$20.07	$34.68
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.68 / $39.17 / $69.43	Professional	TC	$21.68	$39.17	$69.43
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $53.00 / $97.90 / $212.84	Facility		$53.00	$97.90	$212.84
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $28.04 / $36.72 / $98.27	Professional		$28.04	$36.72	$98.27
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $9.10 / $12.48 / $31.39	Professional	26	$9.10	$12.48	$31.39
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $18.52 / $24.44 / $58.74	Professional	TC	$18.52	$24.44	$58.74
Cigna Facility/Professional Facility Modifier Low / Median / High Price $48.29 / $225.99 / $483.01	Facility		$48.29	$225.99	$483.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.95 / $11.95 / $11.95	Facility	26	$11.95	$11.95	$11.95
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $26.10 / $26.10 / $26.10	Facility	TC	$26.10	$26.10	$26.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.70 / $40.92 / $89.20	Professional		$27.70	$40.92	$89.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.14 / $13.77 / $29.10	Professional	26	$9.14	$13.77	$29.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.36 / $27.56 / $64.48	Professional	TC	$18.36	$27.56	$64.48
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $27.47 / $43.37 / $58.55	Professional		$27.47	$43.37	$58.55
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.34 / $11.56 / $15.61	Professional	26	$9.34	$11.56	$15.61
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.13 / $31.81 / $42.94	Professional	TC	$18.13	$31.81	$42.94
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $47.80 / $47.80 / $77.00	Professional		$47.80	$47.80	$77.00
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $9.28 / $9.28 / $28.00	Professional	26	$9.28	$9.28	$28.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $32.86 / $43.24 / $69.59	Professional		$32.86	$43.24	$69.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $13.87 / $21.96	Professional	26	$10.23	$13.87	$21.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.45 / $36.86 / $59.75	Professional	TC	$25.45	$36.86	$59.75
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $110.50 / $359.91 / $359.91	Facility		$110.50	$359.91	$359.91
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $24.59 / $70.00 / $70.00	Facility	26	$24.59	$70.00	$70.00
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $50.00 / $127.63 / $127.63	Facility	TC	$50.00	$127.63	$127.63
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $215.20 / $215.20 / $282.68	Professional		$215.20	$215.20	$282.68
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.04 / $66.04 / $83.48	Professional	26	$66.04	$66.04	$83.48
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $149.15 / $149.15 / $199.20	Professional	TC	$149.15	$149.15	$199.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.78 / $32.34 / $32.34	Professional		$25.78	$32.34	$32.34
Providence Facility/Professional Facility Modifier Low / Median / High Price $29.55 / $44.82 / $139.85	Facility		$29.55	$44.82	$139.85
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $11.95 / $11.95 / $11.95	Facility	26	$11.95	$11.95	$11.95
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $26.10 / $26.10 / $26.10	Facility	TC	$26.10	$26.10	$26.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $29.07 / $46.20 / $89.85	Professional		$29.07	$46.20	$89.85
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.19 / $13.68 / $29.06	Professional	26	$9.19	$13.68	$29.06
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $18.70 / $27.47 / $61.38	Professional	TC	$18.70	$27.47	$61.38
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $108.38 / $108.38 / $108.38	Professional		$108.38	$108.38	$108.38
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $35.60 / $35.60 / $35.60	Professional	26	$35.60	$35.60	$35.60
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $72.77 / $72.77 / $72.77	Professional	TC	$72.77	$72.77	$72.77
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $35.07 / $39.46 / $48.22	Professional		$35.07	$39.46	$48.22
United Facility/Professional Facility Modifier Low / Median / High Price $38.67 / $47.78 / $47.78	Facility		$38.67	$47.78	$47.78
United Facility/Professional Professional Modifier Low / Median / High Price $24.44 / $34.21 / $81.80	Professional		$24.44	$34.21	$81.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.81 / $11.97 / $31.03	Professional	26	$8.81	$11.97	$31.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.63 / $23.01 / $67.63	Professional	TC	$15.63	$23.01	$67.63