Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Facility		$204.17	$204.17	$204.17
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.05 / $19.05 / $19.05	Facility	TC	$19.05	$19.05	$19.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.14 / $20.89 / $67.61	Professional		$15.14	$20.89	$67.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $16.22 / $66.07	Professional	26	$8.91	$16.22	$66.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $5.89 / $7.94 / $28.18	Professional	TC	$5.89	$7.94	$28.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $10.96 / $10.96 / $10.96	Professional		$10.96	$10.96	$10.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.62 / $19.50 / $60.26	Professional	26	$5.62	$19.50	$60.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $22.91 / $67.61	Professional		$17.38	$22.91	$67.61
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $16.22 / $39.81	Professional	26	$11.75	$16.22	$39.81
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $4.27 / $7.24 / $26.92	Professional	TC	$4.27	$7.24	$26.92
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $23.99 / $54.95	Professional		$17.78	$23.99	$54.95
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $16.60 / $38.90	Professional	26	$12.88	$16.60	$38.90
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $5.37 / $6.92 / $16.60	Professional	TC	$5.37	$6.92	$16.60
Cigna Facility/Professional Facility Modifier Low / Median / High Price $19.95 / $19.95 / $19.95	Facility		$19.95	$19.95	$19.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $13.18 / $40.74	Professional		$9.77	$13.18	$40.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.17 / $7.59 / $22.91	Professional	26	$6.17	$7.59	$22.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $3.24 / $5.50 / $16.98	Professional	TC	$3.24	$5.50	$16.98
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $7.94 / $24.55 / $33.11	Professional		$7.94	$24.55	$33.11
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.31 / $13.18 / $17.78	Professional	26	$6.31	$13.18	$17.78
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $1.58 / $11.48 / $15.49	Professional	TC	$1.58	$11.48	$15.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $23.44 / $38.02	Professional		$19.50	$23.44	$38.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $15.49 / $19.95	Professional	26	$10.72	$15.49	$19.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $8.51 / $12.59 / $16.98	Professional	TC	$8.51	$12.59	$16.98
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $131.83 / $131.83	Facility		$131.83	$131.83	$131.83
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 $100.00 / $100.00 / $100.00	Facility	TC	$100.00	$100.00	$100.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $169.82 / $169.82	Professional		$131.83	$169.82	$169.82
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $97.72 / $97.72	Professional	26	$95.50	$97.72	$97.72
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $95.50 / $95.50	Professional	TC	$95.50	$95.50	$95.50
Providence Facility/Professional Facility Modifier Low / Median / High Price $16.60 / $26.30 / $39.81	Facility		$16.60	$26.30	$39.81
Providence Facility/Professional Professional Modifier Low / Median / High Price $10.00 / $18.62 / $58.88	Professional		$10.00	$18.62	$58.88
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $6.31 / $9.33 / $27.54	Professional	26	$6.31	$9.33	$27.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $3.72 / $5.62 / $18.62	Professional	TC	$3.72	$5.62	$18.62
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $81.28 / $81.28	Professional		$81.28	$81.28	$81.28
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $46.77 / $46.77	Professional	26	$46.77	$46.77	$46.77
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $33.88 / $33.88	Professional	TC	$33.88	$33.88	$33.88
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $19.95 / $27.54	Professional		$19.95	$19.95	$27.54
United Facility/Professional Facility Modifier Low / Median / High Price $12.02 / $12.02 / $12.02	Facility		$12.02	$12.02	$12.02
United Facility/Professional Professional Modifier Low / Median / High Price $10.96 / $13.49 / $52.48	Professional		$10.96	$13.49	$52.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $7.94 / $30.20	Professional	26	$6.76	$7.94	$30.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $3.80 / $5.62 / $22.91	Professional	TC	$3.80	$5.62	$22.91