Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.83 / $388.50 / $921.82	Facility		$63.83	$388.50	$921.82
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.19 / $11.57 / $55.63	Facility	26	$9.19	$11.57	$55.63
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.26 / $266.22 / $743.32	Facility	TC	$30.26	$266.22	$743.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.62 / $46.02 / $147.00	Professional		$21.62	$46.02	$147.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.56 / $12.82 / $52.32	Professional	26	$8.56	$12.82	$52.32
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $19.27 / $71.06 / $225.00	Professional	50	$19.27	$71.06	$225.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.14 / $30.87 / $104.00	Professional	TC	$19.14	$30.87	$104.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.60 / $38.96 / $85.32	Professional		$28.60	$38.96	$85.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.65 / $9.65 / $19.61	Professional	26	$6.65	$9.65	$19.61
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $46.75 / $74.34 / $108.61	Professional	50	$46.75	$74.34	$108.61
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $24.24 / $30.15 / $53.23	Professional	TC	$24.24	$30.15	$53.23
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $10.62 / $177.90 / $876.00	Facility		$10.62	$177.90	$876.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.22 / $39.94 / $78.42	Professional		$30.22	$39.94	$78.42
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.59 / $12.16 / $25.41	Professional	26	$9.59	$12.16	$25.41
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $40.71 / $47.22 / $74.77	Professional	50	$40.71	$47.22	$74.77
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.46 / $27.78 / $53.01	Professional	TC	$20.46	$27.78	$53.01
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $54.55 / $97.40 / $231.59	Facility		$54.55	$97.40	$231.59
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $28.53 / $36.11 / $91.89	Professional		$28.53	$36.11	$91.89
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $8.73 / $11.14 / $26.50	Professional	26	$8.73	$11.14	$26.50
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $19.48 / $24.57 / $60.27	Professional	TC	$19.48	$24.57	$60.27
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.21 / $225.99 / $483.01	Facility		$53.21	$225.99	$483.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $29.08 / $29.08 / $29.08	Facility	TC	$29.08	$29.08	$29.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.43 / $41.13 / $85.64	Professional		$27.43	$41.13	$85.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.14 / $11.45 / $25.47	Professional	26	$8.14	$11.45	$25.47
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $39.20 / $39.20 / $44.46	Professional	50	$39.20	$39.20	$44.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.54 / $29.10 / $67.20	Professional	TC	$19.54	$29.10	$67.20
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $25.86 / $45.18 / $60.99	Professional		$25.86	$45.18	$60.99
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.02 / $10.15 / $13.70	Professional	26	$8.02	$10.15	$13.70
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.84 / $35.03 / $47.29	Professional	TC	$17.84	$35.03	$47.29
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $18.98 / $18.98 / $18.98	Professional	26	$18.98	$18.98	$18.98
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $44.80 / $75.58	Professional		$33.11	$44.80	$75.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $12.18 / $19.27	Professional	26	$8.91	$12.18	$19.27
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.02 / $40.58 / $65.78	Professional	TC	$28.02	$40.58	$65.78
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $114.85 / $359.91 / $359.91	Facility		$114.85	$359.91	$359.91
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $27.00 / $100.00 / $100.00	Facility	26	$27.00	$100.00	$100.00
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $140.51 / $140.51	Facility	TC	$100.00	$140.51	$140.51
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $221.82 / $221.82 / $292.13	Professional		$221.82	$221.82	$292.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $89.16 / $89.16 / $89.16	Professional	26	$89.16	$89.16	$89.16
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $177.00 / $177.00 / $219.00	Professional	TC	$177.00	$177.00	$219.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.35 / $32.34 / $32.34	Professional		$28.35	$32.34	$32.34
Providence Facility/Professional Facility Modifier Low / Median / High Price $30.90 / $46.75 / $88.36	Facility		$30.90	$46.75	$88.36
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $29.08 / $29.08 / $29.08	Facility	TC	$29.08	$29.08	$29.08
Providence Facility/Professional Professional Modifier Low / Median / High Price $28.54 / $45.30 / $92.55	Professional		$28.54	$45.30	$92.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $8.14 / $11.29 / $25.35	Professional	26	$8.14	$11.29	$25.35
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $20.25 / $28.65 / $61.72	Professional	TC	$20.25	$28.65	$61.72
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $109.78 / $109.78 / $109.78	Professional		$109.78	$109.78	$109.78
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $30.99 / $30.99 / $30.99	Professional	26	$30.99	$30.99	$30.99
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $78.78 / $78.78 / $78.78	Professional	TC	$78.78	$78.78	$78.78
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $36.54 / $50.24 / $63.34	Professional		$36.54	$50.24	$63.34
United Facility/Professional Facility Modifier Low / Median / High Price $40.20 / $173.25 / $173.25	Facility		$40.20	$173.25	$173.25
United Facility/Professional Professional Modifier Low / Median / High Price $23.02 / $34.40 / $94.97	Professional		$23.02	$34.40	$94.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.10 / $10.19 / $24.05	Professional	26	$7.10	$10.19	$24.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.48 / $24.14 / $71.06	Professional	TC	$16.48	$24.14	$71.06