Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $165.96 / $537.03	Facility	26	$85.11	$165.96	$537.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $346.74 / $1,096.48	Professional		$173.78	$346.74	$1,096.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $147.91 / $371.54	Professional	26	$81.28	$147.91	$371.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $194.98 / $489.78	Professional		$141.25	$194.98	$489.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $204.17 / $426.58	Professional	26	$128.82	$204.17	$426.58
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $288.40 / $501.19	Professional		$204.17	$288.40	$501.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $128.82 / $245.47	Professional	26	$97.72	$128.82	$245.47
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $323.59 / $616.60	Professional		$223.87	$323.59	$616.60
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $151.36 / $288.40	Professional	26	$107.15	$151.36	$288.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.88 / $102.33 / $144.54	Facility	26	$21.88	$102.33	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $257.04 / $457.09	Professional		$158.49	$257.04	$457.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $120.23 / $229.09	Professional	26	$81.28	$120.23	$229.09
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $234.42 / $316.23	Professional		$158.49	$234.42	$316.23
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $104.71 / $141.25	Professional	26	$81.28	$104.71	$141.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $223.87 / $436.52	Professional		$173.78	$223.87	$436.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $125.89 / $218.78	Professional	26	$93.33	$125.89	$218.78
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $575.44 / $575.44 / $575.44	Facility	26	$575.44	$575.44	$575.44
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,479.11 / $1,479.11 / $1,513.56	Professional		$1,479.11	$1,479.11	$1,513.56
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $630.96 / $707.95 / $707.95	Professional	26	$630.96	$707.95	$707.95
Molina Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $169.82 / $295.12	Professional		$117.49	$169.82	$295.12
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $21.88 / $102.33 / $144.54	Facility	26	$21.88	$102.33	$144.54
Providence Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $269.15 / $467.74	Professional		$162.18	$269.15	$467.74
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $114.82 / $223.87	Professional	26	$79.43	$114.82	$223.87
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $588.84 / $588.84	Professional		$588.84	$588.84	$588.84
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 $158.49 / $213.80 / $269.15	Professional		$158.49	$213.80	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $186.21 / $398.11	Professional		$144.54	$186.21	$398.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $97.72 / $194.98	Professional	26	$67.61	$97.72	$194.98