Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $75.68 / $424.15 / $931.50	Facility		$75.68	$424.15	$931.50
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.80 / $10.77 / $53.86	Facility	26	$8.80	$10.77	$53.86
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $34.63 / $220.78 / $585.14	Facility	TC	$34.63	$220.78	$585.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.92 / $56.07 / $207.00	Professional		$29.92	$56.07	$207.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.56 / $13.95 / $55.00	Professional	26	$8.56	$13.95	$55.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $62.88 / $127.69 / $297.00	Professional	50	$62.88	$127.69	$297.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.30 / $19.43 / $113.15	Professional	52	$14.30	$19.43	$113.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.44 / $35.26 / $144.00	Professional	TC	$24.44	$35.26	$144.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $33.53 / $45.91 / $110.34	Professional		$33.53	$45.91	$110.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.67 / $11.26 / $20.54	Professional	26	$6.67	$11.26	$20.54
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $55.09 / $87.65 / $108.88	Professional	50	$55.09	$87.65	$108.88
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $32.51 / $58.97 / $65.76	Professional	TC	$32.51	$58.97	$65.76
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $10.62 / $208.63 / $876.00	Facility		$10.62	$208.63	$876.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.54 / $44.10 / $89.58	Professional		$33.54	$44.10	$89.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.63 / $12.49 / $25.37	Professional	26	$9.63	$12.49	$25.37
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $44.77 / $53.77 / $86.91	Professional	50	$44.77	$53.77	$86.91
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $24.76 / $32.04 / $64.39	Professional	TC	$24.76	$32.04	$64.39
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $54.55 / $97.40 / $231.59	Facility		$54.55	$97.40	$231.59
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $35.26 / $44.42 / $100.00	Professional		$35.26	$44.42	$100.00
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $8.73 / $11.14 / $26.50	Professional	26	$8.73	$11.14	$26.50
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $26.43 / $33.25 / $81.08	Professional	TC	$26.43	$33.25	$81.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $66.58 / $225.99 / $483.01	Facility		$66.58	$225.99	$483.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $35.79 / $35.79 / $35.79	Facility	TC	$35.79	$35.79	$35.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.01 / $46.96 / $102.67	Professional		$32.01	$46.96	$102.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.14 / $11.48 / $25.35	Professional	26	$8.14	$11.48	$25.35
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $48.26 / $48.26 / $54.93	Professional	50	$48.26	$48.26	$54.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.51 / $34.79 / $85.91	Professional	TC	$22.51	$34.79	$85.91
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $23.38 / $53.44 / $72.14	Professional		$23.38	$53.44	$72.14
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $5.85 / $10.15 / $13.70	Professional	26	$5.85	$10.15	$13.70
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.54 / $43.29 / $58.44	Professional	TC	$17.54	$43.29	$58.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $39.02 / $52.80 / $89.04	Professional		$39.02	$52.80	$89.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $12.18 / $19.27	Professional	26	$8.91	$12.18	$19.27
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $34.63 / $50.12 / $81.26	Professional	TC	$34.63	$50.12	$81.26
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $124.65 / $359.91 / $359.91	Facility		$124.65	$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 / $173.52 / $173.52	Facility	TC	$100.00	$173.52	$173.52
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $263.06 / $263.06 / $343.05	Professional		$263.06	$263.06	$343.05
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.26 / $79.26 / $79.26	Professional	26	$79.26	$79.26	$79.26
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $205.55 / $205.55 / $269.93	Professional	TC	$205.55	$205.55	$269.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $34.95	Professional		$32.34	$32.34	$34.95
Providence Facility/Professional Facility Modifier Low / Median / High Price $35.59 / $54.51 / $97.97	Facility		$35.59	$54.51	$97.97
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $35.79 / $35.79 / $35.79	Facility	TC	$35.79	$35.79	$35.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $33.04 / $52.51 / $109.62	Professional		$33.04	$52.51	$109.62
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $8.14 / $11.29 / $24.82	Professional	26	$8.14	$11.29	$24.82
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $47.24 / $47.24 / $47.24	Professional	52	$47.24	$47.24	$47.24
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $22.51 / $34.32 / $77.02	Professional	TC	$22.51	$34.32	$77.02
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $130.22 / $130.22 / $130.22	Professional		$130.22	$130.22	$130.22
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $30.99 / $30.99 / $30.99	Professional	26	$30.99	$30.99	$30.99
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $99.22 / $99.22 / $99.22	Professional	TC	$99.22	$99.22	$99.22
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $35.07 / $48.62 / $59.42	Professional		$35.07	$48.62	$59.42
United Facility/Professional Facility Modifier Low / Median / High Price $47.09 / $47.09 / $47.09	Facility		$47.09	$47.09	$47.09
United Facility/Professional Professional Modifier Low / Median / High Price $25.72 / $39.74 / $117.83	Professional		$25.72	$39.74	$117.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.47 / $10.28 / $23.38	Professional	26	$7.47	$10.28	$23.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.76 / $30.02 / $76.67	Professional	TC	$18.76	$30.02	$76.67