Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.60 / $109.13 / $327.04	Facility	26	$84.60	$109.13	$327.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $238.70 / $344.04 / $1,241.00	Professional		$238.70	$344.04	$1,241.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.42 / $113.94 / $372.50	Professional	26	$59.42	$113.94	$372.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.63 / $195.52 / $517.85	Professional	TC	$151.63	$195.52	$517.85
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $176.37 / $264.58 / $546.71	Professional		$176.37	$264.58	$546.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.95 / $54.67 / $108.83	Professional	26	$39.95	$54.67	$108.83
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $283.79 / $283.79 / $283.79	Professional	TC	$283.79	$283.79	$283.79
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $255.69 / $375.40 / $754.29	Professional		$255.69	$375.40	$754.29
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $78.70 / $119.11 / $207.28	Professional	26	$78.70	$119.11	$207.28
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $165.39 / $245.79 / $557.82	Professional	TC	$165.39	$245.79	$557.82
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $215.29 / $351.60 / $856.26	Professional		$215.29	$351.60	$856.26
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $91.70 / $118.32 / $284.45	Professional	26	$91.70	$118.32	$284.45
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $138.44 / $233.22 / $583.32	Professional	TC	$138.44	$233.22	$583.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.58 / $62.58 / $62.58	Facility	26	$62.58	$62.58	$62.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $298.31 / $439.41 / $875.47	Professional		$298.31	$439.41	$875.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.92 / $96.11 / $177.96	Professional	26	$59.92	$96.11	$177.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $233.30 / $356.18 / $709.88	Professional	TC	$233.30	$356.18	$709.88
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $187.84 / $285.88 / $462.08	Professional		$187.84	$285.88	$462.08
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $59.42 / $65.73 / $98.61	Professional	26	$59.42	$65.73	$98.61
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $122.10 / $185.82 / $381.86	Professional	TC	$122.10	$185.82	$381.86
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $116.17 / $116.17 / $116.17	Professional	26	$116.17	$116.17	$116.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $261.81 / $342.28 / $617.27	Professional		$261.81	$342.28	$617.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.93 / $74.28 / $125.28	Professional	26	$52.93	$74.28	$125.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $218.16 / $331.84 / $554.83	Professional	TC	$218.16	$331.84	$554.83
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $127.27 / $377.88 / $377.88	Facility	26	$127.27	$377.88	$377.88
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,195.03 / $2,362.07 / $2,426.79	Professional		$2,195.03	$2,362.07	$2,426.79
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $480.20 / $507.12 / $521.02	Professional	26	$480.20	$507.12	$521.02
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,755.75 / $1,854.93 / $1,905.76	Professional	TC	$1,755.75	$1,854.93	$1,905.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $281.93	Professional		$32.34	$32.34	$281.93
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $62.58 / $62.58 / $62.58	Facility	26	$62.58	$62.58	$62.58
Providence Facility/Professional Professional Modifier Low / Median / High Price $304.77 / $476.69 / $816.58	Professional		$304.77	$476.69	$816.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $61.89 / $97.76 / $158.11	Professional	26	$61.89	$97.76	$158.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $233.30 / $356.18 / $696.02	Professional	TC	$233.30	$356.18	$696.02
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $928.79 / $928.79 / $928.79	Professional		$928.79	$928.79	$928.79
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $185.13 / $185.13 / $185.13	Professional	26	$185.13	$185.13	$185.13
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $743.66 / $743.66 / $743.66	Professional	TC	$743.66	$743.66	$743.66
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $238.23 / $366.43 / $484.98	Professional		$238.23	$366.43	$484.98
United Facility/Professional Professional Modifier Low / Median / High Price $219.24 / $352.35 / $797.71	Professional		$219.24	$352.35	$797.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.20 / $78.30 / $154.94	Professional	26	$46.20	$78.30	$154.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $173.60 / $278.99 / $649.12	Professional	TC	$173.60	$278.99	$649.12