Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.65 / $585.41 / $1,903.50	Facility		$37.65	$585.41	$1,903.50
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.01 / $14.39 / $82.32	Facility	26	$13.01	$14.39	$82.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.91 / $37.56 / $105.11	Professional		$30.91	$37.56	$105.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.00 / $15.83 / $74.00	Professional	26	$13.00	$15.83	$74.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $21.92 / $46.85	Professional	TC	$17.89	$21.92	$46.85
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.82 / $36.08 / $54.23	Professional		$23.82	$36.08	$54.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.18 / $13.65 / $25.40	Professional	26	$10.18	$13.65	$25.40
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $13.82 / $195.63 / $876.00	Facility		$13.82	$195.63	$876.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.58 / $44.14 / $96.04	Professional		$30.58	$44.14	$96.04
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.38 / $20.17 / $39.97	Professional	26	$13.38	$20.17	$39.97
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.34 / $25.31 / $53.84	Professional	TC	$16.34	$25.31	$53.84
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $47.01 / $87.40 / $174.38	Facility		$47.01	$87.40	$174.38
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $29.82 / $38.40 / $100.00	Professional		$29.82	$38.40	$100.00
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.41 / $17.57 / $47.34	Professional	26	$14.41	$17.57	$47.34
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $15.41 / $19.85 / $54.62	Professional	TC	$15.41	$19.85	$54.62
Cigna Facility/Professional Facility Modifier Low / Median / High Price $42.87 / $75.69 / $89.80	Facility		$42.87	$75.69	$89.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.88 / $15.88 / $15.88	Facility	26	$15.88	$15.88	$15.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.25 / $46.35 / $111.45	Professional		$30.25	$46.35	$111.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.34 / $18.37 / $39.69	Professional	26	$12.34	$18.37	$39.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.00 / $26.94 / $70.34	Professional	TC	$17.00	$26.94	$70.34
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $28.15 / $48.63 / $65.65	Professional		$28.15	$48.63	$65.65
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.39 / $14.52 / $19.60	Professional	26	$12.39	$14.52	$19.60
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $15.76 / $34.11 / $46.05	Professional	TC	$15.76	$34.11	$46.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.21 / $50.54 / $82.67	Professional		$38.21	$50.54	$82.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.07 / $18.14 / $31.65	Professional	26	$13.07	$18.14	$31.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $27.85 / $40.83 / $74.36	Professional	TC	$27.85	$40.83	$74.36
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $78.84 / $514.16 / $539.87	Facility		$78.84	$514.16	$539.87
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $31.93 / $100.00 / $100.00	Facility	26	$31.93	$100.00	$100.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $287.00 / $287.00 / $321.52	Professional		$287.00	$287.00	$321.52
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $108.15 / $204.67 / $204.67	Professional	26	$108.15	$204.67	$204.67
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $230.00 / $230.00 / $230.00	Professional	TC	$230.00	$230.00	$230.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $23.23 / $32.34 / $32.34	Professional		$23.23	$32.34	$32.34
Providence Facility/Professional Facility Modifier Low / Median / High Price $34.42 / $50.38 / $77.36	Facility		$34.42	$50.38	$77.36
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $15.88 / $15.88 / $15.88	Facility	26	$15.88	$15.88	$15.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $32.52 / $50.56 / $105.12	Professional		$32.52	$50.56	$105.12
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.54 / $18.14 / $39.15	Professional	26	$12.54	$18.14	$39.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $17.11 / $26.33 / $66.61	Professional	TC	$17.11	$26.33	$66.61
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $121.20 / $121.20 / $121.20	Professional		$121.20	$121.20	$121.20
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $46.67 / $46.67 / $46.67	Professional	26	$46.67	$46.67	$46.67
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $74.53 / $74.53 / $74.53	Professional	TC	$74.53	$74.53	$74.53
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $28.15 / $42.23 / $54.05	Professional		$28.15	$42.23	$54.05
United Facility/Professional Professional Modifier Low / Median / High Price $26.71 / $37.17 / $92.41	Professional		$26.71	$37.17	$92.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.08 / $14.80 / $36.25	Professional	26	$11.08	$14.80	$36.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.63 / $22.37 / $62.04	Professional	TC	$15.63	$22.37	$62.04