Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.09 / $110.52 / $514.45	Facility	26	$88.09	$110.52	$514.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $280.33 / $451.50 / $1,720.49	Professional		$280.33	$451.50	$1,720.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.25 / $111.94 / $395.65	Professional	26	$84.25	$111.94	$395.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $192.00 / $350.77 / $900.51	Professional	TC	$192.00	$350.77	$900.51
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $213.55 / $320.69 / $589.61	Professional		$213.55	$320.69	$589.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.73 / $92.18 / $192.81	Professional	26	$63.73	$92.18	$192.81
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $146.84 / $374.74 / $374.74	Professional	TC	$146.84	$374.74	$374.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $306.30 / $545.37 / $1,023.60	Professional		$306.30	$545.37	$1,023.60
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $80.20 / $109.48 / $221.86	Professional	26	$80.20	$109.48	$221.86
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $216.10 / $437.78 / $818.30	Professional	TC	$216.10	$437.78	$818.30
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $247.49 / $379.39 / $920.73	Professional		$247.49	$379.39	$920.73
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $80.62 / $109.26 / $266.51	Professional	26	$80.62	$109.26	$266.51
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $174.14 / $271.06 / $638.69	Professional	TC	$174.14	$271.06	$638.69
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.41 / $98.41 / $98.41	Facility	26	$98.41	$98.41	$98.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $254.01 / $477.01 / $939.36	Professional		$254.01	$477.01	$939.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.65 / $104.62 / $241.53	Professional	26	$52.65	$104.62	$241.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $179.74 / $350.46 / $745.71	Professional	TC	$179.74	$350.46	$745.71
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $270.91 / $347.29 / $468.84	Professional		$270.91	$347.29	$468.84
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.56 / $95.33 / $128.69	Professional	26	$78.56	$95.33	$128.69
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $192.35 / $251.96 / $340.15	Professional	TC	$192.35	$251.96	$340.15
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $180.79 / $180.79 / $180.79	Professional	26	$180.79	$180.79	$180.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $272.58 / $368.79 / $612.52	Professional		$272.58	$368.79	$612.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $84.49 / $114.40 / $181.03	Professional	26	$84.49	$114.40	$181.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $212.32 / $318.48 / $516.40	Professional	TC	$212.32	$318.48	$516.40
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $788.32 / $788.32 / $804.96	Facility	26	$788.32	$788.32	$804.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,183.14 / $3,278.63 / $3,278.63	Professional		$3,183.14	$3,278.63	$3,278.63
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $694.28 / $1,009.00 / $1,009.00	Professional	26	$694.28	$1,009.00	$1,009.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,699.58 / $2,780.57 / $2,780.57	Professional	TC	$2,699.58	$2,780.57	$2,780.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $227.11	Professional		$32.34	$32.34	$227.11
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $98.41 / $98.41 / $98.41	Facility	26	$98.41	$98.41	$98.41
Providence Facility/Professional Professional Modifier Low / Median / High Price $259.54 / $534.67 / $873.81	Professional		$259.54	$534.67	$873.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $52.52 / $101.85 / $227.93	Professional	26	$52.52	$101.85	$227.93
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $179.74 / $343.90 / $707.85	Professional	TC	$179.74	$343.90	$707.85
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,010.19 / $1,010.19 / $1,010.19	Professional		$1,010.19	$1,010.19	$1,010.19
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $296.02 / $296.02 / $296.02	Professional	26	$296.02	$296.02	$296.02
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $714.16 / $714.16 / $714.16	Professional	TC	$714.16	$714.16	$714.16
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $280.85 / $379.28 / $460.55	Professional		$280.85	$379.28	$460.55
United Facility/Professional Professional Modifier Low / Median / High Price $261.66 / $388.48 / $846.30	Professional		$261.66	$388.48	$846.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.40 / $97.10 / $221.03	Professional	26	$74.40	$97.10	$221.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $182.52 / $305.02 / $732.21	Professional	TC	$182.52	$305.02	$732.21