Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $295.12 / $676.08	Facility	26	$141.25	$295.12	$676.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $478.63 / $1,862.09	Professional		$288.40	$478.63	$1,862.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $263.03 / $263.03	Professional		$263.03	$263.03	$263.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $645.65 / $1,122.02	Professional		$407.38	$645.65	$1,122.02
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $537.03 / $1,000.00	Professional		$371.54	$537.03	$1,000.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $125.89 / $177.83	Facility	26	$26.92	$125.89	$177.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $478.63 / $912.01	Professional		$251.19	$478.63	$912.01
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $407.38 / $489.78	Professional		$363.08	$407.38	$489.78
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $138.04 / $169.82	Professional	26	$125.89	$138.04	$169.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $363.08 / $724.44	Professional		$269.15	$363.08	$724.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $144.54 / $263.03	Professional	26	$112.20	$144.54	$263.03
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,000.00 / $1,000.00 / $1,000.00	Facility	26	$1,000.00	$1,000.00	$1,000.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,162.28 / $3,162.28 / $3,162.28	Professional		$3,162.28	$3,162.28	$3,162.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $131.83 / $281.84	Professional		$32.36	$131.83	$281.84
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $125.89 / $177.83	Facility	26	$26.92	$125.89	$177.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $512.86 / $831.76	Professional		$263.03	$512.86	$831.76
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,071.52 / $1,071.52	Professional		$1,071.52	$1,071.52	$1,071.52
United Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $371.54 / $794.33	Professional		$275.42	$371.54	$794.33