Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $128.82 / $151.36	Facility		$112.20	$128.82	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $147.91 / $398.11	Professional		$102.33	$147.91	$398.11
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $446.68 / $446.68 / $446.68	Professional	25	$446.68	$446.68	$446.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $125.89 / $177.83	Professional		$95.50	$125.89	$177.83
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $147.91 / $158.49	Facility		$147.91	$147.91	$158.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $158.49 / $323.59	Professional		$104.71	$158.49	$323.59
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $186.21 / $186.21 / $186.21	Facility		$186.21	$186.21	$186.21
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $194.98 / $363.08	Professional		$104.71	$194.98	$363.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $199.53 / $263.03	Facility		$199.53	$199.53	$263.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $134.90 / $234.42	Professional		$85.11	$134.90	$234.42
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $165.96 / $234.42	Professional		$97.72	$165.96	$234.42
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $125.89 / $177.83	Professional		$79.43	$125.89	$177.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $158.49 / $245.47	Professional		$109.65	$158.49	$245.47
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $812.83 / $812.83 / $812.83	Facility		$812.83	$812.83	$812.83
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $977.24 / $1,258.93	Professional		$169.82	$977.24	$1,258.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $199.53 / $288.40	Professional		$33.11	$199.53	$288.40
Optum Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $147.91 / $239.88	Professional		$102.33	$147.91	$239.88
Providence Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $162.18 / $239.88	Facility		$131.83	$162.18	$239.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $134.90 / $245.47	Professional		$85.11	$134.90	$245.47
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $407.38 / $446.68	Professional		$407.38	$407.38	$446.68
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $158.49 / $218.78	Professional		$123.03	$158.49	$218.78
United Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $123.03 / $162.18	Facility		$104.71	$123.03	$162.18
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $138.04 / $281.84	Professional		$100.00	$138.04	$281.84