Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $416.87 / $933.25	Facility		$75.86	$416.87	$933.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $11.48 / $28.84	Facility	26	$8.91	$11.48	$28.84
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $34.67 / $151.36 / $478.63	Facility	TC	$34.67	$151.36	$478.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.79 / $53.70 / $204.17	Professional		$14.79	$53.70	$204.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $17.78 / $54.95	Professional	26	$8.51	$17.78	$54.95
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $21.88 / $102.33 / $251.19	Professional	50	$21.88	$102.33	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $44.67 / $144.54	Professional	TC	$24.55	$44.67	$144.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $42.66 / $75.86	Professional		$31.62	$42.66	$75.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $14.45 / $22.91	Professional	26	$7.76	$14.45	$22.91
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $40.74 / $48.98 / $147.91	Professional	50	$40.74	$48.98	$147.91
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $35.48 / $66.07	Professional	TC	$24.55	$35.48	$66.07
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $10.72 / $11.75 / $229.09	Facility		$10.72	$11.75	$229.09
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $47.86 / $95.50	Professional		$35.48	$47.86	$95.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $13.80 / $26.30	Professional	26	$9.77	$13.80	$26.30
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $45.71 / $57.54 / $89.13	Professional	50	$45.71	$57.54	$89.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $34.67 / $72.44	Professional	TC	$25.70	$34.67	$72.44
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $102.33 / $263.03	Facility		$57.54	$102.33	$263.03
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $53.70 / $104.71	Professional		$39.81	$53.70	$104.71
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $13.80 / $25.12	Professional	26	$10.47	$13.80	$25.12
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $39.81 / $81.28	Professional	TC	$29.51	$39.81	$81.28
Cigna Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $199.53 / $524.81	Facility		$66.07	$199.53	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.19 / $10.23 / $14.79	Facility	26	$2.19	$10.23	$14.79
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $7.41 / $34.67 / $48.98	Facility	TC	$7.41	$34.67	$48.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $47.86 / $93.33	Professional		$32.36	$47.86	$93.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $11.75 / $22.91	Professional	26	$8.13	$11.75	$22.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $34.67 / $74.13	Professional	TC	$22.39	$34.67	$74.13
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $57.54 / $77.62	Professional		$23.44	$57.54	$77.62
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $5.89 / $10.96 / $14.79	Professional	26	$5.89	$10.96	$14.79
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $46.77 / $63.10	Professional	TC	$17.38	$46.77	$63.10
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $19.05 / $19.05	Professional	26	$19.05	$19.05	$19.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $53.70 / $91.20	Professional		$41.69	$53.70	$91.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $12.59 / $20.42	Professional	26	$9.55	$12.59	$20.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $50.12 / $87.10	Professional	TC	$38.02	$50.12	$87.10
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $363.08 / $363.08	Facility		$263.03	$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 $204.17 / $204.17 / $204.17	Facility	TC	$204.17	$204.17	$204.17
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $346.74 / $346.74	Professional		$61.66	$346.74	$346.74
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $79.43 / $79.43	Professional	26	$79.43	$79.43	$79.43
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $269.15 / $269.15	Professional	TC	$204.17	$269.15	$269.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $10.72 / $33.11 / $45.71	Professional		$10.72	$33.11	$45.71
Providence Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $54.95 / $102.33	Facility		$35.48	$54.95	$102.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.19 / $10.23 / $14.79	Facility	26	$2.19	$10.23	$14.79
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $7.41 / $34.67 / $48.98	Facility	TC	$7.41	$34.67	$48.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $48.98 / $102.33	Professional		$32.36	$48.98	$102.33
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $11.22 / $21.88	Professional	26	$7.94	$11.22	$21.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $33.11 / $70.79	Professional	TC	$22.39	$33.11	$70.79
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $128.82 / $128.82	Professional		$128.82	$128.82	$128.82
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $30.90 / $30.90	Professional	26	$30.90	$30.90	$30.90
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $100.00 / $100.00	Professional	TC	$100.00	$100.00	$100.00
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $47.86 / $60.26	Professional		$34.67	$47.86	$60.26
United Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $144.54 / $218.78	Facility		$138.04	$144.54	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $39.81 / $85.11	Professional		$25.70	$39.81	$85.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $9.77 / $19.50	Professional	26	$7.08	$9.77	$19.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $30.20 / $64.57	Professional	TC	$18.62	$30.20	$64.57