Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $34.34 / $352.80 / $803.25	Facility		$34.34	$352.80	$803.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.12 / $8.43 / $43.60	Facility	26	$7.12	$8.43	$43.60
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.27 / $100.96 / $394.12	Facility	TC	$23.27	$100.96	$394.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.62 / $38.68 / $153.00	Professional		$24.62	$38.68	$153.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.71 / $11.09 / $43.60	Professional	26	$6.71	$11.09	$43.60
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $21.50 / $76.58 / $265.93	Professional	50	$21.50	$76.58	$265.93
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.55 / $15.35 / $159.60	Professional	52	$11.55	$15.35	$159.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $22.10 / $81.90	Professional	TC	$17.89	$22.10	$81.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.61 / $37.18 / $62.69	Professional		$23.61	$37.18	$62.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.44 / $8.19 / $14.79	Professional	26	$5.44	$8.19	$14.79
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $31.80 / $31.80 / $31.80	Professional	50	$31.80	$31.80	$31.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.19 / $23.19 / $23.19	Professional	TC	$23.19	$23.19	$23.19
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 $25.62 / $34.56 / $69.11	Professional		$25.62	$34.56	$69.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.25 / $10.41 / $20.66	Professional	26	$8.25	$10.41	$20.66
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $34.89 / $39.03 / $58.09	Professional	50	$34.89	$39.03	$58.09
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.60 / $24.34 / $49.00	Professional	TC	$18.60	$24.34	$49.00
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 $24.87 / $32.06 / $77.06	Professional		$24.87	$32.06	$77.06
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $7.06 / $8.93 / $20.93	Professional	26	$7.06	$8.93	$20.93
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $18.38 / $23.19 / $57.06	Professional	TC	$18.38	$23.19	$57.06
Cigna Facility/Professional Facility Modifier Low / Median / High Price $43.36 / $225.99 / $483.01	Facility		$43.36	$225.99	$483.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.51 / $8.51 / $8.51	Facility	26	$8.51	$8.51	$8.51
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $23.86 / $23.86 / $23.86	Facility	TC	$23.86	$23.86	$23.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.48 / $35.54 / $74.87	Professional		$23.48	$35.54	$74.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.48 / $9.60 / $20.51	Professional	26	$6.48	$9.60	$20.51
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $35.13 / $35.13 / $39.76	Professional	50	$35.13	$35.13	$39.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.16 / $25.83 / $58.15	Professional	TC	$17.16	$25.83	$58.15
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $17.30 / $36.67 / $49.50	Professional		$17.30	$36.67	$49.50
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $4.84 / $8.07 / $10.89	Professional	26	$4.84	$8.07	$10.89
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $12.46 / $28.60 / $38.61	Professional	TC	$12.46	$28.60	$38.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $26.96 / $36.47 / $58.60	Professional		$26.96	$36.47	$58.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.20 / $9.72 / $15.32	Professional	26	$7.20	$9.72	$15.32
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $22.88 / $33.15 / $53.73	Professional	TC	$22.88	$33.15	$53.73
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $97.41 / $359.91 / $359.91	Facility		$97.41	$359.91	$359.91
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $22.09 / $100.00 / $100.00	Facility	26	$22.09	$100.00	$100.00
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $114.81 / $114.81	Facility	TC	$100.00	$114.81	$114.81
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $180.63 / $180.63 / $238.88	Professional		$180.63	$180.63	$238.88
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 $154.00 / $154.00 / $179.40	Professional	TC	$154.00	$154.00	$179.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $23.22 / $32.34 / $32.34	Professional		$23.22	$32.34	$32.34
Providence Facility/Professional Facility Modifier Low / Median / High Price $25.59 / $38.09 / $72.94	Facility		$25.59	$38.09	$72.94
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $8.51 / $8.51 / $8.51	Facility	26	$8.51	$8.51	$8.51
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $23.86 / $23.86 / $23.86	Facility	TC	$23.86	$23.86	$23.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $24.24 / $38.74 / $75.47	Professional		$24.24	$38.74	$75.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $6.57 / $9.40 / $20.30	Professional	26	$6.57	$9.40	$20.30
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $31.25 / $31.25 / $32.53	Professional	52	$31.25	$31.25	$32.53
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $17.16 / $25.46 / $54.93	Professional	TC	$17.16	$25.46	$54.93
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $91.85 / $91.85 / $91.85	Professional		$91.85	$91.85	$91.85
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $25.08 / $25.08 / $25.08	Professional	26	$25.08	$25.08	$25.08
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $66.76 / $66.76 / $66.76	Professional	TC	$66.76	$66.76	$66.76
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $25.96 / $34.75 / $42.20	Professional		$25.96	$34.75	$42.20
United Facility/Professional Facility Modifier Low / Median / High Price $20.00 / $36.00 / $119.70	Facility		$20.00	$36.00	$119.70
United Facility/Professional Professional Modifier Low / Median / High Price $20.18 / $29.60 / $76.98	Professional		$20.18	$29.60	$76.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.09 / $7.99 / $18.64	Professional	26	$6.09	$7.99	$18.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $14.49 / $21.20 / $51.94	Professional	TC	$14.49	$21.20	$51.94