Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $158.49 / $549.54	Facility	26	$81.28	$158.49	$549.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $251.19 / $588.84	Professional		$134.90	$251.19	$588.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $91.20 / $288.40	Professional	26	$77.62	$91.20	$288.40
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $125.89	Professional		$125.89	$125.89	$125.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $75.86 / $114.82	Professional	26	$74.13	$75.86	$114.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $363.08 / $776.25	Professional		$190.55	$363.08	$776.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $158.49 / $354.81	Professional	26	$93.33	$158.49	$354.81
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $380.19 / $676.08	Professional		$263.03	$380.19	$676.08
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $125.89 / $239.88	Professional	26	$89.13	$125.89	$239.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $107.15 / $151.36	Facility	26	$22.91	$107.15	$151.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $275.42 / $676.08	Professional		$141.25	$275.42	$676.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $114.82 / $229.09	Professional	26	$77.62	$114.82	$229.09
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $190.55 / $257.04	Professional		$141.25	$190.55	$257.04
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $100.00 / $138.04	Professional	26	$69.18	$100.00	$138.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $186.21 / $323.59	Professional		$147.91	$186.21	$323.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $117.49 / $190.55	Professional	26	$91.20	$117.49	$190.55
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $588.84 / $588.84 / $588.84	Facility	26	$588.84	$588.84	$588.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,467.37 / $3,467.37 / $3,467.37	Professional		$3,467.37	$3,467.37	$3,467.37
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $630.96 / $758.58 / $758.58	Professional	26	$630.96	$758.58	$758.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $70.79 / $181.97	Professional		$32.36	$70.79	$181.97
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $107.15 / $151.36	Facility	26	$22.91	$107.15	$151.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $295.12 / $676.08	Professional		$144.54	$295.12	$676.08
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $107.15 / $204.17	Professional	26	$77.62	$107.15	$204.17
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $562.34 / $562.34	Professional		$562.34	$562.34	$562.34
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $309.03 / $309.03 / $309.03	Professional	26	$309.03	$309.03	$309.03
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $213.80 / $691.83	Professional		$154.88	$213.80	$691.83
United Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $213.80 / $575.44	Professional		$154.88	$213.80	$575.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $100.00 / $194.98	Professional	26	$69.18	$100.00	$194.98