Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.31 / $95.29 / $506.47	Facility	26	$80.31	$95.29	$506.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $265.26 / $443.77 / $1,506.92	Professional		$265.26	$443.77	$1,506.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.65 / $99.93 / $371.91	Professional	26	$75.65	$99.93	$371.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $192.00 / $351.12 / $882.03	Professional	TC	$192.00	$351.12	$882.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $115.81 / $282.97 / $1,498.20	Professional		$115.81	$282.97	$1,498.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.28 / $89.36 / $185.38	Professional	26	$62.28	$89.36	$185.38
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $302.73 / $547.54 / $1,004.58	Professional		$302.73	$547.54	$1,004.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $83.29 / $114.50 / $222.40	Professional	26	$83.29	$114.50	$222.40
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $215.31 / $438.74 / $807.24	Professional	TC	$215.31	$438.74	$807.24
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $242.22 / $371.44 / $901.08	Professional		$242.22	$371.44	$901.08
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $77.41 / $105.01 / $254.71	Professional	26	$77.41	$105.01	$254.71
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $171.75 / $267.35 / $632.48	Professional	TC	$171.75	$267.35	$632.48
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 $250.69 / $508.49 / $1,002.64	Professional		$250.69	$508.49	$1,002.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.08 / $98.30 / $232.70	Professional	26	$50.08	$98.30	$232.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $177.57 / $413.16 / $813.99	Professional	TC	$177.57	$413.16	$813.99
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $265.18 / $343.62 / $463.89	Professional		$265.18	$343.62	$463.89
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.25 / $91.66 / $123.74	Professional	26	$74.25	$91.66	$123.74
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $190.93 / $251.96 / $340.15	Professional	TC	$190.93	$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 $267.25 / $361.57 / $635.00	Professional		$267.25	$361.57	$635.00
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 $209.84 / $314.76 / $510.39	Professional	TC	$209.84	$314.76	$510.39
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 / $3,248.56 / $3,248.56	Professional		$2,893.96	$3,248.56	$3,248.56
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $662.48 / $880.00 / $880.00	Professional	26	$662.48	$880.00	$880.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,441.41 / $2,762.21 / $2,765.07	Professional	TC	$2,441.41	$2,762.21	$2,765.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $224.18	Professional		$32.34	$32.34	$224.18
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 $259.62 / $550.44 / $882.85	Professional		$259.62	$550.44	$882.85
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $47.26 / $94.47 / $231.33	Professional	26	$47.26	$94.47	$231.33
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $177.57 / $414.87 / $782.75	Professional	TC	$177.57	$414.87	$782.75
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $987.70 / $987.70 / $987.70	Professional		$987.70	$987.70	$987.70
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 $703.35 / $703.35 / $703.35	Professional	TC	$703.35	$703.35	$703.35
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $277.89 / $371.26 / $450.81	Professional		$277.89	$371.26	$450.81
United Facility/Professional Professional Modifier Low / Median / High Price $255.84 / $411.55 / $890.49	Professional		$255.84	$411.55	$890.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.03 / $90.10 / $211.33	Professional	26	$68.03	$90.10	$211.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $179.76 / $322.45 / $712.05	Professional	TC	$179.76	$322.45	$712.05