Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.18 / $290.33 / $811.50	Facility		$37.18	$290.33	$811.50
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.48 / $9.13 / $49.25	Facility	26	$7.48	$9.13	$49.25
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.08 / $96.59 / $434.01	Facility	TC	$24.08	$96.59	$434.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.35 / $39.22 / $143.19	Professional		$24.35	$39.22	$143.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $10.19 / $43.09	Professional	26	$7.03	$10.19	$43.09
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $30.00 / $65.48 / $240.85	Professional	50	$30.00	$65.48	$240.85
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.64 / $15.96 / $91.32	Professional	52	$11.64	$15.96	$91.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.53 / $23.16 / $95.08	Professional	TC	$18.53	$23.16	$95.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.39 / $42.08 / $71.12	Professional		$26.39	$42.08	$71.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.67 / $7.93 / $17.98	Professional	26	$5.67	$7.93	$17.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $44.39 / $50.44 / $50.44	Professional	TC	$44.39	$50.44	$50.44
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $8.75 / $169.00 / $876.00	Facility		$8.75	$169.00	$876.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.09 / $36.03 / $71.94	Professional		$28.09	$36.03	$71.94
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.31 / $10.58 / $20.93	Professional	26	$8.31	$10.58	$20.93
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $37.11 / $42.41 / $59.74	Professional	50	$37.11	$42.41	$59.74
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.23 / $25.54 / $51.01	Professional	TC	$20.23	$25.54	$51.01
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $51.68 / $94.98 / $199.44	Facility		$51.68	$94.98	$199.44
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $28.79 / $37.08 / $85.91	Professional		$28.79	$37.08	$85.91
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $7.75 / $9.86 / $22.76	Professional	26	$7.75	$9.86	$22.76
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $21.41 / $27.31 / $61.47	Professional	TC	$21.41	$27.31	$61.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $51.10 / $225.99 / $483.01	Facility		$51.10	$225.99	$483.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.86 / $8.86 / $8.86	Facility	26	$8.86	$8.86	$8.86
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $27.59 / $27.59 / $27.59	Facility	TC	$27.59	$27.59	$27.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.77 / $37.99 / $82.78	Professional		$25.77	$37.99	$82.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.06 / $9.93 / $22.27	Professional	26	$7.06	$9.93	$22.27
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $40.11 / $40.11 / $45.51	Professional	50	$40.11	$40.11	$45.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.48 / $27.81 / $66.63	Professional	TC	$18.48	$27.81	$66.63
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $19.02 / $41.72 / $56.32	Professional		$19.02	$41.72	$56.32
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $5.14 / $8.52 / $11.52	Professional	26	$5.14	$8.52	$11.52
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $13.88 / $33.19 / $44.81	Professional	TC	$13.88	$33.19	$44.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $30.57 / $41.35 / $67.25	Professional		$30.57	$41.35	$67.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.55 / $10.24 / $16.19	Professional	26	$7.55	$10.24	$16.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $26.55 / $38.46 / $62.33	Professional	TC	$26.55	$38.46	$62.33
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $81.16 / $359.91 / $359.91	Facility		$81.16	$359.91	$359.91
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $19.63 / $100.00 / $100.00	Facility	26	$19.63	$100.00	$100.00
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $133.13 / $133.13	Facility	TC	$100.00	$133.13	$133.13
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $206.66 / $206.66 / $270.00	Professional		$206.66	$206.66	$270.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.70 / $67.70 / $67.70	Professional	26	$67.70	$67.70	$67.70
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $157.81 / $157.81 / $207.68	Professional	TC	$157.81	$157.81	$207.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.25 / $32.34 / $32.34	Professional		$27.25	$32.34	$32.34
Providence Facility/Professional Facility Modifier Low / Median / High Price $28.04 / $42.73 / $78.58	Facility		$28.04	$42.73	$78.58
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $8.86 / $8.86 / $8.86	Facility	26	$8.86	$8.86	$8.86
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $27.59 / $27.59 / $27.59	Facility	TC	$27.59	$27.59	$27.59
Providence Facility/Professional Professional Modifier Low / Median / High Price $27.00 / $41.89 / $86.26	Professional		$27.00	$41.89	$86.26
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.06 / $9.80 / $20.90	Professional	26	$7.06	$9.80	$20.90
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $37.17 / $37.17 / $37.17	Professional	52	$37.17	$37.17	$37.17
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.09 / $26.87 / $62.37	Professional	TC	$19.09	$26.87	$62.37
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $105.07 / $105.07 / $105.07	Professional		$105.07	$105.07	$105.07
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $27.49 / $27.49 / $27.49	Professional	26	$27.49	$27.49	$27.49
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $77.58 / $77.58 / $77.58	Professional	TC	$77.58	$77.58	$77.58
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $28.54 / $37.95 / $46.39	Professional		$28.54	$37.95	$46.39
United Facility/Professional Facility Modifier Low / Median / High Price $37.13 / $133.88 / $133.88	Facility		$37.13	$133.88	$133.88
United Facility/Professional Professional Modifier Low / Median / High Price $20.75 / $32.11 / $90.96	Professional		$20.75	$32.11	$90.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.08 / $9.06 / $24.02	Professional	26	$6.08	$9.06	$24.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $14.77 / $23.46 / $79.39	Professional	TC	$14.77	$23.46	$79.39