Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $66.06 / $347.40 / $844.74	Facility		$66.06	$347.40	$844.74
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $12.69 / $63.96	Facility	26	$10.47	$12.69	$63.96
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $40.09 / $267.24 / $497.20	Facility	TC	$40.09	$267.24	$497.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.52 / $55.26 / $175.99	Professional		$28.52	$55.26	$175.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.02 / $14.31 / $52.02	Professional	26	$10.02	$14.31	$52.02
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $46.08 / $46.08 / $46.08	Professional	50	$46.08	$46.08	$46.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.55 / $38.34 / $135.49	Professional	TC	$27.55	$38.34	$135.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $39.32 / $52.22 / $117.87	Professional		$39.32	$52.22	$117.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.92 / $11.48 / $21.89	Professional	26	$7.92	$11.48	$21.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $39.27 / $67.67 / $76.89	Professional	TC	$39.27	$67.67	$76.89
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $17.88 / $244.00 / $876.00	Facility		$17.88	$244.00	$876.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.45 / $78.09 / $139.29	Professional		$44.45	$78.09	$139.29
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.20 / $19.45 / $34.97	Professional	26	$11.20	$19.45	$34.97
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $50.55 / $65.77 / $93.78	Professional	50	$50.55	$65.77	$93.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $34.38 / $58.50 / $104.31	Professional	TC	$34.38	$58.50	$104.31
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $57.07 / $100.00 / $318.68	Facility		$57.07	$100.00	$318.68
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $38.21 / $50.22 / $118.26	Professional		$38.21	$50.22	$118.26
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $3.90 / $4.91 / $15.45	Professional	26	$3.90	$4.91	$15.45
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $34.47 / $45.31 / $105.73	Professional	TC	$34.47	$45.31	$105.73
Cigna Facility/Professional Facility Modifier Low / Median / High Price $75.72 / $225.99 / $483.01	Facility		$75.72	$225.99	$483.01
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 $41.38 / $41.38 / $41.38	Facility	TC	$41.38	$41.38	$41.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.96 / $56.52 / $124.94	Professional		$37.96	$56.52	$124.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.44 / $14.18 / $30.18	Professional	26	$9.44	$14.18	$30.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.58 / $42.33 / $99.04	Professional	TC	$28.58	$42.33	$99.04
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $37.28 / $62.65 / $84.58	Professional		$37.28	$62.65	$84.58
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.69 / $12.02 / $16.23	Professional	26	$9.69	$12.02	$16.23
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.59 / $50.63 / $68.34	Professional	TC	$27.59	$50.63	$68.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $45.75 / $61.89 / $104.44	Professional		$45.75	$61.89	$104.44
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 $40.50 / $58.61 / $95.01	Professional	TC	$40.50	$58.61	$95.01
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $94.81 / $359.91 / $359.91	Facility		$94.81	$359.91	$359.91
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.00 / $70.00 / $70.00	Facility	26	$50.00	$70.00	$70.00
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $85.00 / $202.87 / $202.87	Facility	TC	$85.00	$202.87	$202.87
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $301.95 / $301.95 / $401.48	Professional		$301.95	$301.95	$401.48
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $68.20 / $68.20 / $86.33	Professional	26	$68.20	$68.20	$86.33
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $233.75 / $233.75 / $315.14	Professional	TC	$233.75	$233.75	$315.14
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $40.09	Professional		$32.34	$32.34	$40.09
Providence Facility/Professional Facility Modifier Low / Median / High Price $40.89 / $64.55 / $153.54	Facility		$40.89	$64.55	$153.54
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 $41.38 / $41.38 / $41.38	Facility	TC	$41.38	$41.38	$41.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $41.12 / $63.93 / $125.79	Professional		$41.12	$63.93	$125.79
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.52 / $13.95 / $30.09	Professional	26	$9.52	$13.95	$30.09
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $29.21 / $41.73 / $94.80	Professional	TC	$29.21	$41.73	$94.80
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $150.44 / $150.44 / $150.44	Professional		$150.44	$150.44	$150.44
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 $113.64 / $113.64 / $113.64	Professional	TC	$113.64	$113.64	$113.64
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $48.47 / $57.01 / $69.67	Professional		$48.47	$57.01	$69.67
United Facility/Professional Facility Modifier Low / Median / High Price $54.75 / $54.75 / $54.75	Facility		$54.75	$54.75	$54.75
United Facility/Professional Professional Modifier Low / Median / High Price $32.97 / $47.86 / $115.65	Professional		$32.97	$47.86	$115.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.10 / $12.13 / $28.53	Professional	26	$9.10	$12.13	$28.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.87 / $34.70 / $96.16	Professional	TC	$23.87	$34.70	$96.16