Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.27 / $96.84 / $496.90	Facility	26	$87.27	$96.84	$496.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $240.93 / $349.28 / $1,136.00	Professional		$240.93	$349.28	$1,136.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.76 / $119.19 / $388.66	Professional	26	$86.76	$119.19	$388.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $152.34 / $172.59 / $408.52	Professional	TC	$152.34	$172.59	$408.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $202.45 / $255.65 / $1,218.20	Professional		$202.45	$255.65	$1,218.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $68.65 / $71.44 / $153.77	Professional	26	$68.65	$71.44	$153.77
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $291.57 / $425.03 / $757.20	Professional		$291.57	$425.03	$757.20
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $101.33 / $178.80 / $324.86	Professional	26	$101.33	$178.80	$324.86
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $157.16 / $254.77 / $496.36	Professional	TC	$157.16	$254.77	$496.36
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $192.48 / $314.56 / $765.63	Professional		$192.48	$314.56	$765.63
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $89.12 / $107.99 / $264.79	Professional	26	$89.12	$107.99	$264.79
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $123.17 / $207.56 / $500.87	Professional	TC	$123.17	$207.56	$500.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.46 / $93.46 / $93.46	Facility	26	$93.46	$93.46	$93.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $258.22 / $359.39 / $744.34	Professional		$258.22	$359.39	$744.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.36 / $122.00 / $252.09	Professional	26	$90.36	$122.00	$252.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.72 / $231.83 / $516.57	Professional	TC	$162.72	$231.83	$516.57
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $247.29 / $296.75 / $397.20	Professional		$247.29	$296.75	$397.20
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $90.77 / $122.54 / $148.38	Professional	26	$90.77	$122.54	$148.38
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $123.65 / $203.45 / $274.66	Professional	TC	$123.65	$203.45	$274.66
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $297.43 / $297.43 / $297.43	Professional		$297.43	$297.43	$297.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $230.09 / $297.73 / $554.12	Professional		$230.09	$297.73	$554.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $80.22 / $113.06 / $190.26	Professional	26	$80.22	$113.06	$190.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $162.76 / $238.77 / $399.23	Professional	TC	$162.76	$238.77	$399.23
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $192.51 / $366.35 / $399.24	Facility	26	$192.51	$366.35	$399.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,380.40 / $2,380.40 / $2,380.40	Professional		$2,380.40	$2,380.40	$2,380.40
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $520.19 / $520.19 / $647.63	Professional	26	$520.19	$520.19	$647.63
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $982.86 / $982.86 / $1,266.38	Professional	TC	$982.86	$982.86	$1,266.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $202.99	Professional		$32.34	$32.34	$202.99
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $93.46 / $93.46 / $93.46	Facility	26	$93.46	$93.46	$93.46
Providence Facility/Professional Professional Modifier Low / Median / High Price $264.14 / $385.29 / $696.26	Professional		$264.14	$385.29	$696.26
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $90.36 / $120.62 / $230.31	Professional	26	$90.36	$120.62	$230.31
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $162.72 / $226.46 / $479.91	Professional	TC	$162.72	$226.46	$479.91
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $783.24 / $783.24 / $783.24	Professional		$783.24	$783.24	$783.24
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $278.80 / $278.80 / $278.80	Professional	26	$278.80	$278.80	$278.80
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $504.43 / $504.43 / $504.43	Professional	TC	$504.43	$504.43	$504.43
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $237.94 / $327.17 / $420.39	Professional		$237.94	$327.17	$420.39
United Facility/Professional Professional Modifier Low / Median / High Price $192.27 / $286.02 / $675.39	Professional		$192.27	$286.02	$675.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.77 / $101.65 / $227.87	Professional	26	$67.77	$101.65	$227.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $122.08 / $176.81 / $424.74	Professional	TC	$122.08	$176.81	$424.74