Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $371.54 / $891.25	Facility		$57.54	$371.54	$891.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.08 / $9.55 / $23.44	Facility	26	$7.08	$9.55	$23.44
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.70 / $112.20 / $457.09	Facility	TC	$25.70	$112.20	$457.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $13.80 / $38.02 / $120.23	Professional		$13.80	$38.02	$120.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $14.45 / $44.67	Professional	26	$7.08	$14.45	$44.67
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $16.98 / $79.43 / $251.19	Professional	50	$16.98	$79.43	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $31.62 / $109.65	Professional	TC	$18.20	$31.62	$109.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $30.90 / $54.95	Professional		$19.95	$30.90	$54.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $12.88 / $18.20	Professional	26	$6.46	$12.88	$18.20
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $79.43 / $79.43 / $79.43	Professional	50	$79.43	$79.43	$79.43
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $13.49 / $20.42 / $27.54	Professional	TC	$13.49	$20.42	$27.54
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $8.71 / $9.77 / $154.88	Facility		$8.71	$9.77	$154.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $38.90 / $77.62	Professional		$28.18	$38.90	$77.62
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $11.22 / $21.88	Professional	26	$8.32	$11.22	$21.88
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $36.31 / $42.66 / $63.10	Professional	50	$36.31	$42.66	$63.10
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $28.18 / $56.23	Professional	TC	$20.42	$28.18	$56.23
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $102.33 / $239.88	Facility		$54.95	$102.33	$239.88
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $40.74 / $79.43	Professional		$28.84	$40.74	$79.43
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $11.48 / $20.89	Professional	26	$8.71	$11.48	$20.89
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $28.18 / $58.88	Professional	TC	$19.50	$28.18	$58.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $199.53 / $524.81	Facility		$44.67	$199.53	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $1.86 / $8.71 / $12.59	Facility	26	$1.86	$8.71	$12.59
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $5.01 / $23.44 / $33.88	Facility	TC	$5.01	$23.44	$33.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $36.31 / $67.61	Professional		$24.55	$36.31	$67.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.00 / $19.95	Professional	26	$7.08	$10.00	$19.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $26.30 / $51.29	Professional	TC	$17.38	$26.30	$51.29
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $38.90 / $52.48	Professional		$20.89	$38.90	$52.48
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $8.91 / $12.02	Professional	26	$6.46	$8.91	$12.02
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $29.51 / $39.81	Professional	TC	$14.45	$29.51	$39.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $36.31 / $66.07	Professional		$28.18	$36.31	$66.07
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $10.23 / $16.60	Professional	26	$7.59	$10.23	$16.60
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $32.36 / $56.23	Professional	TC	$24.55	$32.36	$56.23
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $186.21 / $363.08 / $363.08	Facility		$186.21	$363.08	$363.08
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $138.04 / $138.04 / $138.04	Facility	TC	$138.04	$138.04	$138.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $245.47 / $245.47	Professional		$44.67	$245.47	$245.47
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $64.57 / $64.57	Professional	26	$64.57	$64.57	$64.57
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $186.21 / $186.21	Professional	TC	$162.18	$186.21	$186.21
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.12 / $32.36 / $33.11	Professional		$9.12	$32.36	$33.11
Providence Facility/Professional Facility Modifier Low / Median / High Price $26.30 / $39.81 / $77.62	Facility		$26.30	$39.81	$77.62
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $1.86 / $8.71 / $12.59	Facility	26	$1.86	$8.71	$12.59
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $5.01 / $23.44 / $33.88	Facility	TC	$5.01	$23.44	$33.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $38.02 / $74.13	Professional		$24.55	$38.02	$74.13
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $9.55 / $19.05	Professional	26	$6.92	$9.55	$19.05
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $25.12 / $47.86	Professional	TC	$17.38	$25.12	$47.86
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $95.50 / $95.50	Professional		$95.50	$95.50	$95.50
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $27.54 / $27.54	Professional	26	$27.54	$27.54	$27.54
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $67.61 / $67.61	Professional	TC	$67.61	$67.61	$67.61
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $38.90 / $50.12	Professional		$30.90	$38.90	$50.12
United Facility/Professional Facility Modifier Low / Median / High Price $25.12 / $138.04 / $218.78	Facility		$25.12	$138.04	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $29.51 / $61.66	Professional		$20.89	$29.51	$61.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $8.71 / $17.38	Professional	26	$6.03	$8.71	$17.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $20.42 / $44.67	Professional	TC	$15.14	$20.42	$44.67