Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $107.10 / $412.60 / $968.25	Facility		$107.10	$412.60	$968.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.78 / $9.50 / $51.19	Facility	26	$7.78	$9.50	$51.19
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $32.79 / $272.30 / $536.45	Facility	TC	$32.79	$272.30	$536.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.64 / $47.00 / $165.00	Professional		$21.64	$47.00	$165.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.56 / $13.48 / $52.80	Professional	26	$7.56	$13.48	$52.80
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $55.20 / $90.30 / $302.00	Professional	50	$55.20	$90.30	$302.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.64 / $38.93 / $132.00	Professional	TC	$21.64	$38.93	$132.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.78 / $49.18 / $92.18	Professional		$30.78	$49.18	$92.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.16 / $10.22 / $17.18	Professional	26	$6.16	$10.22	$17.18
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $46.74 / $80.34 / $115.51	Professional	50	$46.74	$80.34	$115.51
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $29.77 / $53.98 / $60.19	Professional	TC	$29.77	$53.98	$60.19
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $9.57 / $191.77 / $876.00	Facility		$9.57	$191.77	$876.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.31 / $39.61 / $76.28	Professional		$30.31	$39.61	$76.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.00 / $11.39 / $22.20	Professional	26	$9.00	$11.39	$22.20
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $40.75 / $48.08 / $77.09	Professional	50	$40.75	$48.08	$77.09
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.26 / $28.56 / $57.01	Professional	TC	$22.26	$28.56	$57.01
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $53.00 / $95.98 / $210.87	Facility		$53.00	$95.98	$210.87
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $30.87 / $38.44 / $97.37	Professional		$30.87	$38.44	$97.37
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $8.07 / $10.27 / $23.67	Professional	26	$8.07	$10.27	$23.67
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $22.04 / $27.77 / $68.00	Professional	TC	$22.04	$27.77	$68.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $58.84 / $225.99 / $483.01	Facility		$58.84	$225.99	$483.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.61 / $9.61 / $9.61	Facility	26	$9.61	$9.61	$9.61
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $32.44 / $32.44 / $32.44	Facility	TC	$32.44	$32.44	$32.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.99 / $42.27 / $91.35	Professional		$27.99	$42.27	$91.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.42 / $10.60 / $23.42	Professional	26	$7.42	$10.60	$23.42
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $43.28 / $43.28 / $49.18	Professional	50	$43.28	$43.28	$49.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.71 / $30.99 / $76.97	Professional	TC	$20.71	$30.99	$76.97
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $25.14 / $48.96 / $66.09	Professional		$25.14	$48.96	$66.09
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.79 / $9.34 / $12.61	Professional	26	$6.79	$9.34	$12.61
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.35 / $39.61 / $53.49	Professional	TC	$18.35	$39.61	$53.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $35.78 / $48.40 / $80.00	Professional		$35.78	$48.40	$80.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.23 / $11.21 / $17.73	Professional	26	$8.23	$11.21	$17.73
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 $104.96 / $359.91 / $359.91	Facility		$104.96	$359.91	$359.91
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $24.54 / $100.00 / $100.00	Facility	26	$24.54	$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 $234.86 / $234.86 / $315.00	Professional		$234.86	$234.86	$315.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.70 / $67.70 / $67.73	Professional	26	$67.70	$67.70	$67.73
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $181.68 / $181.68 / $247.28	Professional	TC	$181.68	$181.68	$247.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $31.65 / $32.34 / $32.34	Professional		$31.65	$32.34	$32.34
Providence Facility/Professional Facility Modifier Low / Median / High Price $32.47 / $46.92 / $89.79	Facility		$32.47	$46.92	$89.79
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.61 / $9.61 / $9.61	Facility	26	$9.61	$9.61	$9.61
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $32.44 / $32.44 / $32.44	Facility	TC	$32.44	$32.44	$32.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $29.73 / $47.02 / $97.94	Professional		$29.73	$47.02	$97.94
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.46 / $10.39 / $23.37	Professional	26	$7.46	$10.39	$23.37
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $20.71 / $30.44 / $67.59	Professional	TC	$20.71	$30.44	$67.59
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $115.84 / $115.84 / $115.84	Professional		$115.84	$115.84	$115.84
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $28.64 / $28.64 / $28.64	Professional	26	$28.64	$28.64	$28.64
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $87.20 / $87.20 / $87.20	Professional	TC	$87.20	$87.20	$87.20
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $37.70 / $50.48 / $61.29	Professional		$37.70	$50.48	$61.29
United Facility/Professional Facility Modifier Low / Median / High Price $42.88 / $157.50 / $157.50	Facility		$42.88	$157.50	$157.50
United Facility/Professional Professional Modifier Low / Median / High Price $23.02 / $35.81 / $89.09	Professional		$23.02	$35.81	$89.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.64 / $9.17 / $21.32	Professional	26	$6.64	$9.17	$21.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.77 / $26.63 / $67.37	Professional	TC	$16.77	$26.63	$67.37