Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.31 / $94.59 / $506.47	Facility	26	$80.31	$94.59	$506.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.64 / $446.12 / $1,547.26	Professional		$275.64	$446.12	$1,547.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.56 / $106.01 / $384.82	Professional	26	$78.56	$106.01	$384.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $192.00 / $351.12 / $760.78	Professional	TC	$192.00	$351.12	$760.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $209.03 / $314.80 / $575.83	Professional		$209.03	$314.80	$575.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.01 / $89.36 / $186.37	Professional	26	$62.01	$89.36	$186.37
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $137.91 / $137.91 / $137.91	Professional	TC	$137.91	$137.91	$137.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $300.29 / $554.79 / $1,003.73	Professional		$300.29	$554.79	$1,003.73
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $83.29 / $115.83 / $226.74	Professional	26	$83.29	$115.83	$226.74
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $215.30 / $438.74 / $806.08	Professional	TC	$215.30	$438.74	$806.08
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $243.11 / $372.83 / $906.63	Professional		$243.11	$372.83	$906.63
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $77.41 / $105.01 / $255.92	Professional	26	$77.41	$105.01	$255.92
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $172.64 / $268.74 / $635.40	Professional	TC	$172.64	$268.74	$635.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.56 / $94.56 / $94.56	Facility	26	$94.56	$94.56	$94.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $252.23 / $504.34 / $935.89	Professional		$252.23	$504.34	$935.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.35 / $98.30 / $231.61	Professional	26	$50.35	$98.30	$231.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $178.81 / $389.70 / $794.88	Professional	TC	$178.81	$389.70	$794.88
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $266.02 / $343.62 / $463.89	Professional		$266.02	$343.62	$463.89
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.48 / $91.66 / $123.74	Professional	26	$74.48	$91.66	$123.74
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $191.53 / $251.96 / $340.15	Professional	TC	$191.53	$251.96	$340.15
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $347.20 / $347.20 / $347.20	Professional	26	$347.20	$347.20	$347.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $267.58 / $362.02 / $601.27	Professional		$267.58	$362.02	$601.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.12 / $109.99 / $172.32	Professional	26	$81.12	$109.99	$172.32
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $210.20 / $315.30 / $511.24	Professional	TC	$210.20	$315.30	$511.24
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $755.84 / $755.84 / $773.84	Facility	26	$755.84	$755.84	$773.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,893.96 / $3,234.12 / $3,234.12	Professional		$2,893.96	$3,234.12	$3,234.12
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $559.72 / $559.72 / $662.48	Professional	26	$559.72	$559.72	$662.48
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,441.41 / $2,749.60 / $2,752.56	Professional	TC	$2,441.41	$2,749.60	$2,752.56
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $224.55	Professional		$32.34	$32.34	$224.55
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $94.56 / $94.56 / $94.56	Facility	26	$94.56	$94.56	$94.56
Providence Facility/Professional Professional Modifier Low / Median / High Price $261.26 / $543.72 / $881.60	Professional		$261.26	$543.72	$881.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.08 / $95.51 / $215.71	Professional	26	$50.08	$95.51	$215.71
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $178.81 / $393.54 / $766.70	Professional	TC	$178.81	$393.54	$766.70
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $988.90 / $988.90 / $988.90	Professional		$988.90	$988.90	$988.90
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $284.35 / $284.35 / $284.35	Professional	26	$284.35	$284.35	$284.35
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $704.55 / $704.55 / $704.55	Professional	TC	$704.55	$704.55	$704.55
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $277.89 / $372.43 / $452.24	Professional		$277.89	$372.43	$452.24
United Facility/Professional Professional Modifier Low / Median / High Price $256.14 / $431.94 / $867.00	Professional		$256.14	$431.94	$867.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.03 / $90.71 / $220.24	Professional	26	$68.03	$90.71	$220.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $180.07 / $334.59 / $746.88	Professional	TC	$180.07	$334.59	$746.88