Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $263.03 / $691.83	Facility		$41.69	$263.03	$691.83
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.13 / $10.96 / $26.92	Facility	26	$8.13	$10.96	$26.92
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.39 / $95.50 / $389.05	Facility	TC	$22.39	$95.50	$389.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $46.77 / $141.25	Professional		$25.12	$46.77	$141.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $13.49 / $45.71	Professional	26	$8.13	$13.49	$45.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $25.70 / $95.50	Professional	TC	$16.60	$25.70	$95.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $28.18 / $60.26	Professional		$20.42	$28.18	$60.26
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $15.14 / $20.89	Professional	26	$7.41	$15.14	$20.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $20.89 / $46.77	Professional	TC	$14.13	$20.89	$46.77
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $14.13 / $15.85 / $158.49	Facility		$14.13	$15.85	$158.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $53.70 / $93.33	Professional		$36.31	$53.70	$93.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $16.98 / $28.18	Professional	26	$11.22	$16.98	$28.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $36.31 / $63.10	Professional	TC	$25.12	$36.31	$63.10
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $104.71 / $239.88	Facility		$52.48	$104.71	$239.88
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $41.69 / $83.18	Professional		$28.84	$41.69	$83.18
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $13.49 / $25.12	Professional	26	$9.55	$13.49	$25.12
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $28.18 / $57.54	Professional	TC	$19.50	$28.18	$57.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $199.53 / $524.81	Facility		$44.67	$199.53	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.14 / $10.00 / $14.13	Facility	26	$2.14	$10.00	$14.13
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $5.01 / $23.44 / $33.11	Facility	TC	$5.01	$23.44	$33.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $36.31 / $70.79	Professional		$25.12	$36.31	$70.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $11.48 / $22.39	Professional	26	$7.59	$11.48	$22.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $25.12 / $51.29	Professional	TC	$16.98	$25.12	$51.29
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $39.81 / $53.70	Professional		$24.55	$39.81	$53.70
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $10.00 / $13.49	Professional	26	$7.94	$10.00	$13.49
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $29.51 / $39.81	Professional	TC	$16.60	$29.51	$39.81
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $24.55 / $46.77	Professional	26	$24.55	$24.55	$46.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $37.15 / $67.61	Professional		$28.84	$37.15	$67.61
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $11.48 / $19.05	Professional	26	$8.71	$11.48	$19.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $31.62 / $54.95	Professional	TC	$23.99	$31.62	$54.95
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $363.08 / $363.08	Facility		$194.98	$363.08	$363.08
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $70.79 / $70.79	Facility	26	$70.79	$70.79	$70.79
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $138.04 / $138.04 / $138.04	Facility	TC	$138.04	$138.04	$138.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $251.19 / $251.19	Professional		$45.71	$251.19	$251.19
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $70.79 / $70.79	Professional	26	$54.95	$70.79	$70.79
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $181.97 / $181.97	Professional	TC	$138.04	$181.97	$181.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $10.47 / $32.36 / $33.88	Professional		$10.47	$32.36	$33.88
Providence Facility/Professional Facility Modifier Low / Median / High Price $25.12 / $40.74 / $95.50	Facility		$25.12	$40.74	$95.50
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.14 / $10.00 / $14.13	Facility	26	$2.14	$10.00	$14.13
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $5.01 / $23.44 / $33.11	Facility	TC	$5.01	$23.44	$33.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $38.02 / $75.86	Professional		$25.12	$38.02	$75.86
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $10.96 / $20.89	Professional	26	$7.59	$10.96	$20.89
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $23.99 / $48.98	Professional	TC	$16.98	$23.99	$48.98
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $95.50 / $95.50	Professional		$95.50	$95.50	$95.50
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $29.51 / $29.51	Professional	26	$29.51	$29.51	$29.51
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $66.07 / $66.07	Professional	TC	$66.07	$66.07	$66.07
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $34.67 / $44.67	Professional		$24.55	$34.67	$44.67
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 $21.88 / $29.51 / $63.10	Professional		$21.88	$29.51	$63.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $9.33 / $19.50	Professional	26	$7.24	$9.33	$19.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $20.42 / $44.67	Professional	TC	$14.45	$20.42	$44.67