Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.54 / $491.83 / $892.62	Facility		$44.54	$491.83	$892.62
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.82 / $11.45 / $65.94	Facility	26	$10.82	$11.45	$65.94
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $32.28 / $167.02 / $585.19	Facility	TC	$32.28	$167.02	$585.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.95 / $49.46 / $170.00	Professional		$35.95	$49.46	$170.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.19 / $12.89 / $46.82	Professional	26	$10.19	$12.89	$46.82
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.28 / $38.29 / $38.29	Professional	50	$38.28	$38.29	$38.29
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $73.01 / $73.01 / $73.01	Professional	52	$73.01	$73.01	$73.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.57 / $29.98 / $109.60	Professional	TC	$25.57	$29.98	$109.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $41.83 / $54.37 / $111.11	Professional		$41.83	$54.37	$111.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.92 / $14.04 / $21.83	Professional	26	$7.92	$14.04	$21.83
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $57.09 / $57.09 / $57.09	Professional	TC	$57.09	$57.09	$57.09
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $18.53 / $211.77 / $876.00	Facility		$18.53	$211.77	$876.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.04 / $74.06 / $127.67	Professional		$39.04	$74.06	$127.67
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.53 / $20.03 / $34.97	Professional	26	$11.53	$20.03	$34.97
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $53.91 / $58.03 / $81.87	Professional	50	$53.91	$58.03	$81.87
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.03 / $54.08 / $95.73	Professional	TC	$29.03	$54.08	$95.73
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $57.10 / $100.00 / $306.66	Facility		$57.10	$100.00	$306.66
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $36.81 / $48.42 / $113.09	Professional		$36.81	$48.42	$113.09
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $4.42 / $5.57 / $16.46	Professional	26	$4.42	$5.57	$16.46
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $32.59 / $42.85 / $100.00	Professional	TC	$32.59	$42.85	$100.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $63.76 / $308.94 / $691.00	Facility		$63.76	$308.94	$691.00
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 $34.29 / $34.29 / $34.29	Facility	TC	$34.29	$34.29	$34.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.57 / $52.02 / $111.02	Professional		$34.57	$52.02	$111.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.75 / $14.40 / $31.08	Professional	26	$9.75	$14.40	$31.08
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $49.64 / $49.64 / $56.50	Professional	50	$49.64	$49.64	$56.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.65 / $37.93 / $84.72	Professional	TC	$25.65	$37.93	$84.72
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $34.79 / $53.93 / $72.81	Professional		$34.79	$53.93	$72.81
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.74 / $12.02 / $16.23	Professional	26	$9.74	$12.02	$16.23
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.06 / $41.91 / $56.58	Professional	TC	$25.06	$41.91	$56.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.60 / $53.45 / $91.68	Professional		$40.60	$53.45	$91.68
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 $33.53 / $48.53 / $78.68	Professional	TC	$33.53	$48.53	$78.68
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $85.00 / $359.91 / $359.91	Facility		$85.00	$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 / $168.01 / $168.01	Facility	TC	$85.00	$168.01	$168.01
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $265.10 / $265.10 / $347.78	Professional		$265.10	$265.10	$347.78
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 $196.89 / $196.89 / $261.45	Professional	TC	$196.89	$196.89	$261.45
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $33.85	Professional		$32.34	$32.34	$33.85
Providence Facility/Professional Facility Modifier Low / Median / High Price $36.07 / $55.78 / $188.89	Facility		$36.07	$55.78	$188.89
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 $34.29 / $34.29 / $34.29	Facility	TC	$34.29	$34.29	$34.29
Providence Facility/Professional Professional Modifier Low / Median / High Price $36.00 / $57.41 / $111.02	Professional		$36.00	$57.41	$111.02
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.75 / $14.24 / $30.18	Professional	26	$9.75	$14.24	$30.18
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $45.18 / $45.18 / $47.63	Professional	52	$45.18	$45.18	$47.63
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $25.83 / $37.36 / $84.72	Professional	TC	$25.83	$37.36	$84.72
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $132.41 / $132.41 / $132.41	Professional		$132.41	$132.41	$132.41
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 $95.61 / $95.61 / $95.61	Professional	TC	$95.61	$95.61	$95.61
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $43.62 / $49.07 / $59.97	Professional		$43.62	$49.07	$59.97
United Facility/Professional Facility Modifier Low / Median / High Price $47.47 / $47.47 / $47.47	Facility		$47.47	$47.47	$47.47
United Facility/Professional Professional Modifier Low / Median / High Price $31.55 / $44.40 / $114.55	Professional		$31.55	$44.40	$114.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.38 / $12.58 / $34.65	Professional	26	$9.38	$12.58	$34.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.17 / $31.75 / $74.37	Professional	TC	$22.17	$31.75	$74.37