Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.89 / $60.63 / $368.52	Facility	26	$57.89	$60.63	$368.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $197.93 / $342.38 / $872.70	Professional		$197.93	$342.38	$872.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.99 / $60.63 / $159.94	Professional	26	$51.99	$60.63	$159.94
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $156.41 / $207.66 / $207.66	Professional		$156.41	$207.66	$207.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.08 / $67.67 / $67.67	Professional	26	$45.08	$67.67	$67.67
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $255.92 / $465.17 / $863.72	Professional		$255.92	$465.17	$863.72
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.63 / $81.23 / $161.68	Professional	26	$56.63	$81.23	$161.68
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $224.62 / $341.94 / $812.23	Professional		$224.62	$341.94	$812.23
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.35 / $76.78 / $185.03	Professional	26	$56.35	$76.78	$185.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $189.57 / $385.54 / $749.08	Professional		$189.57	$385.54	$749.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.54 / $73.83 / $167.87	Professional	26	$36.54	$73.83	$167.87
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $192.38 / $258.36 / $348.79	Professional		$192.38	$258.36	$348.79
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.32 / $66.20 / $89.38	Professional	26	$42.32	$66.20	$89.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $199.87 / $259.58 / $446.82	Professional		$199.87	$259.58	$446.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.65 / $79.45 / $129.11	Professional	26	$58.65	$79.45	$129.11
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $546.72 / $546.72 / $561.91	Facility	26	$546.72	$546.72	$561.91
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,293.84 / $2,362.66 / $2,362.66	Professional		$2,293.84	$2,362.66	$2,362.66
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $523.40 / $523.40 / $523.40	Professional	26	$523.40	$523.40	$523.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $179.29	Professional		$32.34	$32.34	$179.29
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $197.51 / $422.13 / $669.64	Professional		$197.51	$422.13	$669.64
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.09 / $71.75 / $161.00	Professional	26	$36.09	$71.75	$161.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $768.73 / $768.73 / $768.73	Professional		$768.73	$768.73	$768.73
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $206.68 / $206.68 / $206.68	Professional	26	$206.68	$206.68	$206.68
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $208.95 / $287.31 / $618.24	Professional		$208.95	$287.31	$618.24
United Facility/Professional Professional Modifier Low / Median / High Price $198.78 / $298.87 / $664.99	Professional		$198.78	$298.87	$664.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.95 / $64.95 / $153.63	Professional	26	$48.95	$64.95	$153.63