Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.04 / $137.41 / $636.25	Facility	26	$104.04	$137.41	$636.25
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $66.09 / $192.75 / $447.42	Facility	53	$66.09	$192.75	$447.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $256.25 / $351.82 / $666.25	Professional		$256.25	$351.82	$666.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $99.23 / $133.57 / $558.00	Professional	26	$99.23	$133.57	$558.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $93.49 / $141.44 / $514.87	Professional	26	$93.49	$141.44	$514.87
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $285.55 / $526.96 / $832.29	Professional		$285.55	$526.96	$832.29
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $123.20 / $195.20 / $351.30	Professional	26	$123.20	$195.20	$351.30
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $251.82 / $411.45 / $952.52	Professional		$251.82	$411.45	$952.52
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $128.47 / $315.67	Professional	26	$100.00	$128.47	$315.67
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $120.36 / $120.36 / $120.36	Facility	26	$120.36	$120.36	$120.36
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $52.64 / $52.64 / $52.64	Facility	53	$52.64	$52.64	$52.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $268.00 / $384.53 / $783.05	Professional		$268.00	$384.53	$783.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.11 / $150.84 / $309.55	Professional	26	$112.11	$150.84	$309.55
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $155.74 / $292.14 / $394.39	Professional		$155.74	$292.14	$394.39
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $116.38 / $128.02 / $157.11	Professional	26	$116.38	$128.02	$157.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $230.57 / $301.45 / $574.13	Professional		$230.57	$301.45	$574.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $103.22 / $145.21 / $244.40	Professional	26	$103.22	$145.21	$244.40
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $760.56 / $961.28 / $985.36	Facility	26	$760.56	$961.28	$985.36
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $97.84 / $228.96 / $243.44	Facility	53	$97.84	$228.96	$243.44
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,920.39 / $1,920.39 / $1,927.13	Professional		$1,920.39	$1,920.39	$1,927.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $834.53 / $1,030.27 / $1,030.27	Professional	26	$834.53	$1,030.27	$1,030.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $176.55	Professional		$32.34	$32.34	$176.55
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $120.36 / $120.36 / $120.36	Facility	26	$120.36	$120.36	$120.36
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $52.64 / $52.64 / $52.64	Facility	53	$52.64	$52.64	$52.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $276.14 / $411.13 / $717.68	Professional		$276.14	$411.13	$717.68
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $112.22 / $145.57 / $294.83	Professional	26	$112.22	$145.57	$294.83
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $819.04 / $819.04 / $819.04	Professional		$819.04	$819.04	$819.04
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $358.53 / $358.53 / $358.53	Professional	26	$358.53	$358.53	$358.53
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $233.61 / $312.75 / $379.77	Professional		$233.61	$312.75	$379.77
United Facility/Professional Professional Modifier Low / Median / High Price $195.06 / $311.04 / $682.41	Professional		$195.06	$311.04	$682.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.36 / $123.42 / $292.79	Professional	26	$87.36	$123.42	$292.79