Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $426.58 / $891.25	Facility		$75.86	$426.58	$891.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.41 / $10.00 / $41.69	Facility	26	$7.41	$10.00	$41.69
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $31.62 / $162.18 / $616.60	Facility	TC	$31.62	$162.18	$616.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.02 / $45.71 / $151.36	Professional		$12.02	$45.71	$151.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $16.60 / $50.12	Professional	26	$7.76	$16.60	$50.12
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $35.48 / $91.20 / $223.87	Professional	50	$35.48	$91.20	$223.87
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $29.51 / $125.89 / $125.89	Professional	52	$29.51	$125.89	$125.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $42.66 / $125.89	Professional	TC	$22.91	$42.66	$125.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $37.15 / $79.43	Professional		$26.92	$37.15	$79.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $10.96 / $19.05	Professional	26	$6.46	$10.96	$19.05
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $41.69 / $53.70 / $316.23	Professional	50	$41.69	$53.70	$316.23
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $29.51 / $53.70	Professional	TC	$20.42	$29.51	$53.70
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $9.55 / $10.72 / $199.53	Facility		$9.55	$10.72	$199.53
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $42.66 / $89.13	Professional		$32.36	$42.66	$89.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $12.59 / $23.99	Professional	26	$9.12	$12.59	$23.99
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $41.69 / $52.48 / $77.62	Professional	50	$41.69	$52.48	$77.62
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $31.62 / $64.57	Professional	TC	$23.44	$31.62	$64.57
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $102.33 / $245.47	Facility		$56.23	$102.33	$245.47
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $47.86 / $93.33	Professional		$34.67	$47.86	$93.33
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $12.02 / $22.39	Professional	26	$9.12	$12.02	$22.39
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $35.48 / $72.44	Professional	TC	$25.12	$35.48	$72.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $199.53 / $524.81	Facility		$58.88	$199.53	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.04 / $9.55 / $13.49	Facility	26	$2.04	$9.55	$13.49
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $6.46 / $30.20 / $43.65	Facility	TC	$6.46	$30.20	$43.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $42.66 / $83.18	Professional		$28.84	$42.66	$83.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $10.72 / $21.38	Professional	26	$7.41	$10.72	$21.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $31.62 / $64.57	Professional	TC	$20.42	$31.62	$64.57
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $50.12 / $67.61	Professional		$25.12	$50.12	$67.61
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $9.55 / $13.18	Professional	26	$6.76	$9.55	$13.18
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $39.81 / $53.70	Professional	TC	$18.20	$39.81	$53.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $46.77 / $79.43	Professional		$36.31	$46.77	$79.43
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $11.22 / $18.20	Professional	26	$8.32	$11.22	$18.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $43.65 / $75.86	Professional	TC	$33.11	$43.65	$75.86
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $363.08 / $363.08	Facility		$234.42	$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 $181.97 / $181.97 / $181.97	Facility	TC	$181.97	$181.97	$181.97
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $309.03 / $309.03	Professional		$53.70	$309.03	$309.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $70.79 / $70.79	Professional	26	$70.79	$70.79	$70.79
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $239.88 / $239.88	Professional	TC	$181.97	$239.88	$239.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $10.00 / $32.36 / $41.69	Professional		$10.00	$32.36	$41.69
Providence Facility/Professional Facility Modifier Low / Median / High Price $32.36 / $48.98 / $93.33	Facility		$32.36	$48.98	$93.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.04 / $9.55 / $13.49	Facility	26	$2.04	$9.55	$13.49
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $6.46 / $30.20 / $43.65	Facility	TC	$6.46	$30.20	$43.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $44.67 / $91.20	Professional		$29.51	$44.67	$91.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $10.23 / $20.42	Professional	26	$7.41	$10.23	$20.42
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $29.51 / $63.10	Professional	TC	$20.42	$29.51	$63.10
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $114.82 / $114.82	Professional		$114.82	$114.82	$114.82
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $28.84 / $28.84	Professional	26	$28.84	$28.84	$28.84
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $87.10 / $87.10	Professional	TC	$87.10	$87.10	$87.10
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $46.77 / $61.66	Professional		$38.02	$46.77	$61.66
United Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $138.04 / $218.78	Facility		$30.20	$138.04	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $35.48 / $75.86	Professional		$23.44	$35.48	$75.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $9.12 / $18.20	Professional	26	$6.46	$9.12	$18.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $26.30 / $57.54	Professional	TC	$16.60	$26.30	$57.54