Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $354.81 / $933.25	Facility		$46.77	$354.81	$933.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.08 / $9.55 / $22.39	Facility	26	$7.08	$9.55	$22.39
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.55 / $97.72 / $380.19	Facility	TC	$24.55	$97.72	$380.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $39.81 / $208.93	Professional		$17.38	$39.81	$208.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $15.85 / $52.48	Professional	26	$7.08	$15.85	$52.48
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $16.60 / $60.26 / $173.78	Professional	50	$16.60	$60.26	$173.78
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.49 / $173.78 / $234.42	Professional	52	$13.49	$173.78	$234.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $28.84 / $125.89	Professional	TC	$17.78	$28.84	$125.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $30.90 / $61.66	Professional		$20.89	$30.90	$61.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $12.88 / $26.92	Professional	26	$6.46	$12.88	$26.92
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $29.51 / $37.15 / $70.79	Professional	50	$29.51	$37.15	$70.79
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $21.88 / $42.66	Professional	TC	$19.05	$21.88	$42.66
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $8.71 / $9.77 / $165.96	Facility		$8.71	$9.77	$165.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $38.90 / $75.86	Professional		$28.18	$38.90	$75.86
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 $37.15 / $44.67 / $67.61	Professional	50	$37.15	$44.67	$67.61
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $26.92 / $56.23	Professional	TC	$19.95	$26.92	$56.23
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $100.00 / $281.84	Facility		$52.48	$100.00	$281.84
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $39.81 / $79.43	Professional		$28.84	$39.81	$79.43
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $11.48 / $21.38	Professional	26	$8.71	$11.48	$21.38
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $28.84 / $58.88	Professional	TC	$19.95	$28.84	$58.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $245.47 / $691.83	Facility		$47.86	$245.47	$691.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $1.95 / $9.12 / $13.18	Facility	26	$1.95	$9.12	$13.18
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $5.37 / $25.12 / $36.31	Facility	TC	$5.37	$25.12	$36.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $37.15 / $70.79	Professional		$25.12	$37.15	$70.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.23 / $20.42	Professional	26	$7.08	$10.23	$20.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $26.30 / $54.95	Professional	TC	$17.78	$26.30	$54.95
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $41.69 / $56.23	Professional		$17.38	$41.69	$56.23
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $5.37 / $9.33 / $12.59	Professional	26	$5.37	$9.33	$12.59
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $12.02 / $32.36 / $43.65	Professional	TC	$12.02	$32.36	$43.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $39.81 / $69.18	Professional		$30.90	$39.81	$69.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $10.72 / $17.38	Professional	26	$7.94	$10.72	$17.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $35.48 / $61.66	Professional	TC	$26.92	$35.48	$61.66
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $363.08 / $363.08	Facility		$199.53	$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 $147.91 / $147.91 / $147.91	Facility	TC	$147.91	$147.91	$147.91
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $263.03 / $263.03	Professional		$199.53	$263.03	$263.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $64.57 / $64.57	Professional	26	$61.66	$64.57	$64.57
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $199.53 / $199.53	Professional	TC	$154.88	$199.53	$199.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.55 / $32.36 / $35.48	Professional		$9.55	$32.36	$35.48
Providence Facility/Professional Facility Modifier Low / Median / High Price $27.54 / $41.69 / $79.43	Facility		$27.54	$41.69	$79.43
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $1.95 / $9.12 / $13.18	Facility	26	$1.95	$9.12	$13.18
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $5.37 / $25.12 / $36.31	Facility	TC	$5.37	$25.12	$36.31
Providence Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $38.02 / $79.43	Professional		$25.12	$38.02	$79.43
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $9.77 / $19.50	Professional	26	$7.08	$9.77	$19.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $25.12 / $50.12	Professional	TC	$17.78	$25.12	$50.12
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Professional		$100.00	$100.00	$100.00
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 $72.44 / $72.44 / $72.44	Professional	TC	$72.44	$72.44	$72.44
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $35.48 / $44.67	Professional		$25.70	$35.48	$44.67
United Facility/Professional Facility Modifier Low / Median / High Price $25.12 / $165.96 / $263.03	Facility		$25.12	$165.96	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $30.90 / $64.57	Professional		$20.42	$30.90	$64.57
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 $14.79 / $21.88 / $47.86	Professional	TC	$14.79	$21.88	$47.86