Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $71.72 / $405.38 / $865.64	Facility		$71.72	$405.38	$865.64
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.75 / $13.37 / $59.85	Facility	26	$10.75	$13.37	$59.85
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $37.72 / $260.48 / $544.12	Facility	TC	$37.72	$260.48	$544.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.65 / $54.15 / $170.27	Professional		$36.65	$54.15	$170.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.02 / $14.55 / $48.45	Professional	26	$10.02	$14.55	$48.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.62 / $34.81 / $116.00	Professional	TC	$26.62	$34.81	$116.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.74 / $42.32 / $107.44	Professional		$32.74	$42.32	$107.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.92 / $11.67 / $24.33	Professional	26	$7.92	$11.67	$24.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $26.75 / $52.98 / $60.19	Professional	TC	$26.75	$52.98	$60.19
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $12.65 / $203.15 / $876.00	Facility		$12.65	$203.15	$876.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.99 / $49.43 / $98.30	Professional		$35.99	$49.43	$98.30
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.42 / $14.71 / $30.27	Professional	26	$11.42	$14.71	$30.27
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.00 / $34.97 / $69.11	Professional	TC	$25.00	$34.97	$69.11
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $56.30 / $97.90 / $276.64	Facility		$56.30	$97.90	$276.64
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $34.46 / $44.17 / $103.87	Professional		$34.46	$44.17	$103.87
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $10.34 / $13.21 / $31.48	Professional	26	$10.34	$13.21	$31.48
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $24.04 / $30.96 / $85.85	Professional	TC	$24.04	$30.96	$85.85
Cigna Facility/Professional Facility Modifier Low / Median / High Price $60.95 / $272.93 / $681.32	Facility		$60.95	$272.93	$681.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $32.79 / $32.79 / $32.79	Facility	TC	$32.79	$32.79	$32.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.47 / $49.60 / $103.63	Professional		$32.47	$49.60	$103.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.63 / $13.59 / $30.18	Professional	26	$9.63	$13.59	$30.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.08 / $35.96 / $79.23	Professional	TC	$23.08	$35.96	$79.23
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $30.29 / $51.64 / $69.70	Professional		$30.29	$51.64	$69.70
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.39 / $12.02 / $16.23	Professional	26	$9.39	$12.02	$16.23
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.90 / $39.61 / $53.49	Professional	TC	$20.90	$39.61	$53.49
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $56.13 / $56.13 / $56.13	Professional		$56.13	$56.13	$56.13
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $22.52 / $22.52 / $22.52	Professional	26	$22.52	$22.52	$22.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $37.86 / $51.23 / $83.66	Professional		$37.86	$51.23	$83.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.58 / $14.42 / $22.82	Professional	26	$10.58	$14.42	$22.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.70 / $45.89 / $74.38	Professional	TC	$31.70	$45.89	$74.38
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $125.55 / $359.91 / $359.91	Facility		$125.55	$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 / $158.84 / $158.84	Facility	TC	$100.00	$158.84	$158.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $256.38 / $256.38 / $333.60	Professional		$256.38	$256.38	$333.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $82.56 / $82.56 / $135.00	Professional	26	$82.56	$82.56	$135.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $211.00 / $211.00 / $247.28	Professional	TC	$211.00	$211.00	$247.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $32.39	Professional		$32.34	$32.34	$32.39
Providence Facility/Professional Facility Modifier Low / Median / High Price $36.65 / $53.46 / $102.97	Facility		$36.65	$53.46	$102.97
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $32.79 / $32.79 / $32.79	Facility	TC	$32.79	$32.79	$32.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $33.46 / $54.49 / $106.92	Professional		$33.46	$54.49	$106.92
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.63 / $13.49 / $30.09	Professional	26	$9.63	$13.49	$30.09
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $23.39 / $35.61 / $76.98	Professional	TC	$23.39	$35.61	$76.98
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $126.41 / $126.41 / $126.41	Professional		$126.41	$126.41	$126.41
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $36.79 / $36.79 / $36.79	Professional	26	$36.79	$36.79	$36.79
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $89.60 / $89.60 / $89.60	Professional	TC	$89.60	$89.60	$89.60
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $41.76 / $57.42 / $73.87	Professional		$41.76	$57.42	$73.87
United Facility/Professional Facility Modifier Low / Median / High Price $45.94 / $189.00 / $189.00	Facility		$45.94	$189.00	$189.00
United Facility/Professional Professional Modifier Low / Median / High Price $28.71 / $40.19 / $96.61	Professional		$28.71	$40.19	$96.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.85 / $12.00 / $27.77	Professional	26	$8.85	$12.00	$27.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.03 / $28.38 / $69.70	Professional	TC	$21.03	$28.38	$69.70