Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.82 / $352.19 / $831.04	Facility		$42.82	$352.19	$831.04
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.84 / $10.70 / $53.19	Facility	26	$8.84	$10.70	$53.19
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.23 / $130.37 / $455.40	Facility	TC	$27.23	$130.37	$455.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.00 / $41.80 / $144.00	Professional		$24.00	$41.80	$144.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.34 / $12.28 / $51.21	Professional	26	$8.34	$12.28	$51.21
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $18.02 / $78.12 / $255.00	Professional	50	$18.02	$78.12	$255.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.96 / $25.81 / $95.00	Professional	TC	$20.96	$25.81	$95.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.09 / $40.11 / $63.39	Professional		$32.09	$40.11	$63.39
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.42 / $9.89 / $22.76	Professional	26	$6.42	$9.89	$22.76
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $76.55 / $76.55 / $76.55	Professional	50	$76.55	$76.55	$76.55
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $15.11 / $183.08 / $876.00	Facility		$15.11	$183.08	$876.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.33 / $60.55 / $108.79	Professional		$33.33	$60.55	$108.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.28 / $16.34 / $28.30	Professional	26	$9.28	$16.34	$28.30
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $42.09 / $49.57 / $70.65	Professional	50	$42.09	$49.57	$70.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.26 / $44.49 / $79.55	Professional	TC	$25.26	$44.49	$79.55
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $55.40 / $100.00 / $246.21	Facility		$55.40	$100.00	$246.21
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $31.15 / $39.22 / $100.00	Professional		$31.15	$39.22	$100.00
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $3.51 / $4.42 / $13.15	Professional	26	$3.51	$4.42	$13.15
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $26.45 / $34.79 / $92.56	Professional	TC	$26.45	$34.79	$92.56
Cigna Facility/Professional Facility Modifier Low / Median / High Price $55.32 / $225.99 / $483.01	Facility		$55.32	$225.99	$483.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.01 / $10.01 / $10.01	Facility	26	$10.01	$10.01	$10.01
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $30.20 / $30.20	Facility	TC	$30.20	$30.20	$30.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.49 / $43.17 / $94.38	Professional		$29.49	$43.17	$94.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.95 / $11.75 / $25.35	Professional	26	$7.95	$11.75	$25.35
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 $21.24 / $32.13 / $72.70	Professional	TC	$21.24	$32.13	$72.70
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $29.15 / $46.56 / $62.86	Professional		$29.15	$46.56	$62.86
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.16 / $9.69 / $13.08	Professional	26	$8.16	$9.69	$13.08
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.99 / $36.86 / $49.76	Professional	TC	$20.99	$36.86	$49.76
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $35.02 / $46.13 / $77.81	Professional		$35.02	$46.13	$77.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.56 / $11.63 / $18.41	Professional	26	$8.56	$11.63	$18.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.49 / $42.69 / $69.23	Professional	TC	$29.49	$42.69	$69.23
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 $80.81 / $147.82 / $147.82	Facility	TC	$80.81	$147.82	$147.82
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $226.14 / $226.14 / $300.68	Professional		$226.14	$226.14	$300.68
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.28 / $55.28 / $70.34	Professional	26	$55.28	$55.28	$70.34
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $170.86 / $170.86 / $230.33	Professional	TC	$170.86	$170.86	$230.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.82 / $32.34 / $32.34	Professional		$29.82	$32.34	$32.34
Providence Facility/Professional Facility Modifier Low / Median / High Price $31.09 / $48.13 / $139.85	Facility		$31.09	$48.13	$139.85
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.01 / $10.01 / $10.01	Facility	26	$10.01	$10.01	$10.01
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $30.20 / $30.20	Facility	TC	$30.20	$30.20	$30.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $29.81 / $48.29 / $94.73	Professional		$29.81	$48.29	$94.73
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.95 / $11.53 / $24.34	Professional	26	$7.95	$11.53	$24.34
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $21.73 / $31.59 / $69.87	Professional	TC	$21.73	$31.59	$69.87
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $114.59 / $114.59 / $114.59	Professional		$114.59	$114.59	$114.59
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $29.79 / $29.79 / $29.79	Professional	26	$29.79	$29.79	$29.79
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $84.79 / $84.79 / $84.79	Professional	TC	$84.79	$84.79	$84.79
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $37.65 / $42.35 / $51.77	Professional		$37.65	$42.35	$51.77
United Facility/Professional Facility Modifier Low / Median / High Price $40.96 / $40.96 / $40.96	Facility		$40.96	$40.96	$40.96
United Facility/Professional Professional Modifier Low / Median / High Price $25.86 / $36.40 / $88.03	Professional		$25.86	$36.40	$88.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.67 / $10.02 / $24.39	Professional	26	$7.67	$10.02	$24.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.19 / $26.73 / $65.95	Professional	TC	$18.19	$26.73	$65.95