Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.42 / $333.65 / $724.12	Facility		$42.42	$333.65	$724.12
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.73 / $12.63 / $59.56	Facility	26	$9.73	$12.63	$59.56
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.32 / $140.76 / $528.29	Facility	TC	$27.32	$140.76	$528.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.73 / $41.01 / $148.16	Professional		$30.73	$41.01	$148.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.27 / $13.56 / $49.00	Professional	26	$9.27	$13.56	$49.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.03 / $25.22 / $66.19	Professional	TC	$20.03	$25.22	$66.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $27.24 / $34.36 / $59.42	Professional		$27.24	$34.36	$59.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.17 / $10.40 / $21.78	Professional	26	$7.17	$10.40	$21.78
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $26.41 / $43.37 / $48.35	Professional	TC	$26.41	$43.37	$48.35
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $12.43 / $169.06 / $876.00	Facility		$12.43	$169.06	$876.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.94 / $43.92 / $87.80	Professional		$32.94	$43.92	$87.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.28 / $14.47 / $28.58	Professional	26	$11.28	$14.47	$28.58
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.90 / $29.23 / $58.05	Professional	TC	$21.90	$29.23	$58.05
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $56.30 / $97.90 / $269.01	Facility		$56.30	$97.90	$269.01
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $32.42 / $42.06 / $100.00	Professional		$32.42	$42.06	$100.00
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $10.34 / $13.21 / $30.44	Professional	26	$10.34	$13.21	$30.44
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $22.64 / $28.69 / $67.02	Professional	TC	$22.64	$28.69	$67.02
Cigna Facility/Professional Facility Modifier Low / Median / High Price $48.29 / $272.93 / $681.32	Facility		$48.29	$272.93	$681.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.16 / $11.16 / $11.16	Facility	26	$11.16	$11.16	$11.16
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 $28.29 / $43.88 / $91.78	Professional		$28.29	$43.88	$91.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.97 / $13.22 / $28.14	Professional	26	$8.97	$13.22	$28.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.88 / $30.30 / $64.79	Professional	TC	$18.88	$30.30	$64.79
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $28.04 / $42.67 / $57.60	Professional		$28.04	$42.67	$57.60
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.97 / $10.85 / $14.65	Professional	26	$8.97	$10.85	$14.65
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.07 / $31.81 / $42.94	Professional	TC	$19.07	$31.81	$42.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $31.39 / $42.47 / $70.54	Professional		$31.39	$42.47	$70.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.57 / $13.02 / $20.62	Professional	26	$9.57	$13.02	$20.62
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 $114.23 / $359.91 / $359.91	Facility		$114.23	$359.91	$359.91
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $31.90 / $100.00 / $100.00	Facility	26	$31.90	$100.00	$100.00
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $127.63 / $127.63	Facility	TC	$100.00	$127.63	$127.63
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $218.00 / $218.00 / $277.50	Professional		$218.00	$218.00	$277.50
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.52 / $87.52 / $87.52	Professional	26	$87.52	$87.52	$87.52
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $199.20 / $206.00 / $206.00	Professional	TC	$199.20	$206.00	$206.00
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 $30.74 / $48.01 / $85.34	Facility		$30.74	$48.01	$85.34
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $11.16 / $11.16 / $11.16	Facility	26	$11.16	$11.16	$11.16
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 $29.21 / $47.94 / $91.78	Professional		$29.21	$47.94	$91.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $8.97 / $12.95 / $28.00	Professional	26	$8.97	$12.95	$28.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.39 / $30.03 / $63.41	Professional	TC	$19.39	$30.03	$63.41
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $104.87 / $104.87 / $104.87	Professional		$104.87	$104.87	$104.87
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $33.29 / $33.29 / $33.29	Professional	26	$33.29	$33.29	$33.29
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $71.56 / $71.56 / $71.56	Professional	TC	$71.56	$71.56	$71.56
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $34.50 / $47.44 / $73.87	Professional		$34.50	$47.44	$73.87
United Facility/Professional Facility Modifier Low / Median / High Price $37.90 / $189.00 / $189.00	Facility		$37.90	$189.00	$189.00
United Facility/Professional Professional Modifier Low / Median / High Price $26.15 / $35.74 / $87.34	Professional		$26.15	$35.74	$87.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.52 / $11.46 / $27.26	Professional	26	$8.52	$11.46	$27.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.48 / $23.81 / $59.38	Professional	TC	$18.48	$23.81	$59.38