Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.01 / $103.37 / $532.84	Facility	26	$81.01	$103.37	$532.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $301.14 / $375.74 / $1,572.47	Professional		$301.14	$375.74	$1,572.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.01 / $122.49 / $369.00	Professional	26	$81.01	$122.49	$369.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $227.00 / $274.60 / $995.49	Professional	TC	$227.00	$274.60	$995.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $247.21 / $319.48 / $578.85	Professional		$247.21	$319.48	$578.85
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.09 / $89.09 / $194.97	Professional	26	$64.09	$89.09	$194.97
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $198.32 / $411.89 / $459.31	Professional	TC	$198.32	$411.89	$459.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $304.79 / $438.88 / $872.23	Professional		$304.79	$438.88	$872.23
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.48 / $110.15 / $232.78	Professional	26	$77.48	$110.15	$232.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $228.81 / $332.82 / $653.04	Professional	TC	$228.81	$332.82	$653.04
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $257.16 / $394.39 / $980.35	Professional		$257.16	$394.39	$980.35
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $80.98 / $109.71 / $266.93	Professional	26	$80.98	$109.71	$266.93
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $183.51 / $285.58 / $713.44	Professional	TC	$183.51	$285.58	$713.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.40 / $98.40 / $98.40	Facility	26	$98.40	$98.40	$98.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.48 / $410.83 / $939.11	Professional		$213.48	$410.83	$939.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.44 / $105.97 / $242.66	Professional	26	$52.44	$105.97	$242.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $161.04 / $305.25 / $696.65	Professional	TC	$161.04	$305.25	$696.65
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $281.80 / $398.55 / $538.04	Professional		$281.80	$398.55	$538.04
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.90 / $95.78 / $129.30	Professional	26	$78.90	$95.78	$129.30
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $202.90 / $302.77 / $408.74	Professional	TC	$202.90	$302.77	$408.74
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $97.97 / $97.97 / $181.59	Professional	26	$97.97	$97.97	$181.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $286.88 / $395.63 / $636.38	Professional		$286.88	$395.63	$636.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $84.84 / $114.94 / $200.93	Professional	26	$84.84	$114.94	$200.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $233.35 / $350.03 / $567.59	Professional	TC	$233.35	$350.03	$567.59
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $791.44 / $791.44 / $805.76	Facility	26	$791.44	$791.44	$805.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,077.84 / $2,077.84 / $2,569.28	Professional		$2,077.84	$2,077.84	$2,569.28
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $547.02 / $547.02 / $697.13	Professional	26	$547.02	$547.02	$697.13
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,614.00 / $2,614.00 / $2,614.00	Professional	TC	$2,614.00	$2,614.00	$2,614.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $254.78	Professional		$32.34	$32.34	$254.78
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $98.40 / $98.40 / $98.40	Facility	26	$98.40	$98.40	$98.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $235.00 / $474.25 / $896.78	Professional		$235.00	$474.25	$896.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.38 / $101.10 / $234.39	Professional	26	$50.38	$101.10	$234.39
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $150.56 / $295.45 / $665.58	Professional	TC	$150.56	$295.45	$665.58
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,091.93 / $1,091.93 / $1,091.93	Professional		$1,091.93	$1,091.93	$1,091.93
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $297.22 / $297.22 / $297.22	Professional	26	$297.22	$297.22	$297.22
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $794.71 / $794.71 / $794.71	Professional	TC	$794.71	$794.71	$794.71
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $322.33 / $394.52 / $479.06	Professional		$322.33	$394.52	$479.06
United Facility/Professional Professional Modifier Low / Median / High Price $276.83 / $344.85 / $825.58	Professional		$276.83	$344.85	$825.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.06 / $96.24 / $224.17	Professional	26	$74.06	$96.24	$224.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $203.08 / $238.92 / $799.85	Professional	TC	$203.08	$238.92	$799.85