Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.20 / $94.25 / $504.52	Facility	26	$77.20	$94.25	$504.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $187.76 / $233.08 / $1,033.67	Professional		$187.76	$233.08	$1,033.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.15 / $98.02 / $342.00	Professional	26	$75.15	$98.02	$342.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.99 / $141.93 / $592.00	Professional	TC	$112.99	$141.93	$592.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $146.63 / $185.14 / $345.59	Professional		$146.63	$185.14	$345.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $60.76 / $88.34 / $185.62	Professional	26	$60.76	$88.34	$185.62
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $81.70 / $217.82 / $217.82	Professional	TC	$81.70	$217.82	$217.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $196.14 / $281.45 / $547.02	Professional		$196.14	$281.45	$547.02
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $73.86 / $105.99 / $206.00	Professional	26	$73.86	$105.99	$206.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $119.88 / $175.46 / $341.01	Professional	TC	$119.88	$175.46	$341.01
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $164.42 / $250.34 / $614.22	Professional		$164.42	$250.34	$614.22
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $77.48 / $105.05 / $254.99	Professional	26	$77.48	$105.05	$254.99
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $146.21 / $349.96	Professional	TC	$100.00	$146.21	$349.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.15 / $94.15 / $94.15	Facility	26	$94.15	$94.15	$94.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $124.15 / $255.62 / $577.61	Professional		$124.15	$255.62	$577.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.02 / $101.12 / $233.02	Professional	26	$48.02	$101.12	$233.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.13 / $154.86 / $338.07	Professional	TC	$76.13	$154.86	$338.07
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $174.31 / $234.80 / $316.98	Professional		$174.31	$234.80	$316.98
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $73.20 / $91.30 / $123.26	Professional	26	$73.20	$91.30	$123.26
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $101.10 / $143.49 / $193.71	Professional	TC	$101.10	$143.49	$193.71
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $173.73 / $173.73 / $173.73	Professional	26	$173.73	$173.73	$173.73
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $185.14 / $235.00 / $382.92	Professional		$185.14	$235.00	$382.92
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $80.79 / $109.56 / $173.41	Professional	26	$80.79	$109.56	$173.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $110.67 / $166.01 / $269.17	Professional	TC	$110.67	$166.01	$269.17
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $752.64 / $752.64 / $770.72	Facility	26	$752.64	$752.64	$770.72
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,217.23 / $1,217.23 / $1,550.48	Professional		$1,217.23	$1,217.23	$1,550.48
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $521.24 / $521.24 / $659.93	Professional	26	$521.24	$521.24	$659.93
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,308.00 / $1,308.00 / $1,308.00	Professional	TC	$1,308.00	$1,308.00	$1,308.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $117.96	Professional		$32.34	$32.34	$117.96
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $94.15 / $94.15 / $94.15	Facility	26	$94.15	$94.15	$94.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $141.54 / $300.80 / $560.76	Professional		$141.54	$300.80	$560.76
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.65 / $98.34 / $230.98	Professional	26	$45.65	$98.34	$230.98
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $73.94 / $154.86 / $336.20	Professional	TC	$73.94	$154.86	$336.20
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $662.52 / $662.52 / $662.52	Professional		$662.52	$662.52	$662.52
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $283.20 / $283.20 / $283.20	Professional	26	$283.20	$283.20	$283.20
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $379.32 / $379.32 / $379.32	Professional	TC	$379.32	$379.32	$379.32
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $189.86 / $244.03 / $296.32	Professional		$189.86	$244.03	$296.32
United Facility/Professional Professional Modifier Low / Median / High Price $172.70 / $223.50 / $503.65	Professional		$172.70	$223.50	$503.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.77 / $91.81 / $220.35	Professional	26	$70.77	$91.81	$220.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.93 / $125.44 / $320.92	Professional	TC	$96.93	$125.44	$320.92