Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $123.75 / $140.25 / $165.00	Facility		$123.75	$140.25	$165.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $115.16 / $151.27 / $346.71	Professional		$115.16	$151.27	$346.71
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $676.00 / $676.00 / $676.00	Professional	25	$676.00	$676.00	$676.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $80.00 / $141.90 / $250.29	Professional		$80.00	$141.90	$250.29
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $165.45 / $165.45 / $165.45	Professional	25	$165.45	$165.45	$165.45
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $30.26 / $30.26 / $30.26	Professional	52	$30.26	$30.26	$30.26
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $188.97 / $203.19 / $203.19	Facility		$188.97	$203.19	$203.19
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $98.11 / $176.40 / $326.33	Professional		$98.11	$176.40	$326.33
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $185.51 / $267.10 / $267.10	Facility		$185.51	$267.10	$267.10
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $110.00 / $183.60 / $306.00	Professional		$110.00	$183.60	$306.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $108.00 / $154.00 / $273.43	Professional		$108.00	$154.00	$273.43
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $128.08 / $174.47 / $237.92	Professional		$128.08	$174.47	$237.92
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $123.10 / $170.89 / $338.23	Professional		$123.10	$170.89	$338.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.00 / $168.00 / $282.22	Professional		$125.00	$168.00	$282.22
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $669.10 / $713.45 / $713.45	Facility		$669.10	$713.45	$713.45
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $947.18 / $1,103.45 / $1,377.38	Professional		$947.18	$1,103.45	$1,377.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $249.22 / $328.96	Professional		$32.34	$249.22	$328.96
Optum Facility/Professional Professional Modifier Low / Median / High Price $121.19 / $167.73 / $239.37	Professional		$121.19	$167.73	$239.37
Providence Facility/Professional Facility Modifier Low / Median / High Price $144.72 / $175.62 / $240.24	Facility		$144.72	$175.62	$240.24
Providence Facility/Professional Professional Modifier Low / Median / High Price $103.00 / $146.00 / $248.57	Professional		$103.00	$146.00	$248.57
Sutter Health Plus Facility/Professional Facility Modifier Low / Median / High Price $110.00 / $187.00 / $285.00	Facility		$110.00	$187.00	$285.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $122.24 / $170.09 / $241.19	Professional		$122.24	$170.09	$241.19
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $144.24 / $175.16 / $214.08	Professional		$144.24	$175.16	$214.08
United Facility/Professional Facility Modifier Low / Median / High Price $197.93 / $197.93 / $197.93	Facility		$197.93	$197.93	$197.93
United Facility/Professional Professional Modifier Low / Median / High Price $109.47 / $163.87 / $326.02	Professional		$109.47	$163.87	$326.02