Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $47.54 / $85.03 / $209.18	Facility		$47.54	$85.03	$209.18
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $163.80 / $225.00 / $225.00	Facility	25	$163.80	$225.00	$225.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.65 / $83.52 / $254.00	Professional		$46.65	$83.52	$254.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $59.51 / $94.42 / $268.56	Professional	25	$59.51	$94.42	$268.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $69.84 / $140.99	Professional		$50.00	$69.84	$140.99
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $50.00 / $69.94 / $122.29	Professional	25	$50.00	$69.94	$122.29
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $52.98 / $61.48 / $69.62	Facility		$52.98	$61.48	$69.62
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.98 / $76.59 / $139.40	Professional		$52.98	$76.59	$139.40
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $88.30 / $115.00 / $139.00	Facility		$88.30	$115.00	$139.00
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $63.52 / $86.82 / $186.53	Professional		$63.52	$86.82	$186.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $87.43 / $150.00 / $180.00	Facility		$87.43	$150.00	$180.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $49.03 / $78.53 / $158.96	Professional		$49.03	$78.53	$158.96
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $34.29 / $57.31 / $104.38	Professional		$34.29	$57.31	$104.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $46.89 / $77.70 / $135.99	Professional		$46.89	$77.70	$135.99
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $211.96 / $229.71 / $229.71	Facility		$211.96	$229.71	$229.71
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $302.33 / $456.37 / $456.37	Professional		$302.33	$456.37	$456.37
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $70.00	Professional		$32.34	$32.34	$70.00
Optum Facility/Professional Professional Modifier Low / Median / High Price $65.50 / $83.95 / $215.99	Professional		$65.50	$83.95	$215.99
Providence Facility/Professional Facility Modifier Low / Median / High Price $45.16 / $70.98 / $110.24	Facility		$45.16	$70.98	$110.24
Providence Facility/Professional Professional Modifier Low / Median / High Price $51.68 / $86.27 / $172.57	Professional		$51.68	$86.27	$172.57
Sutter Health Plus Facility/Professional Facility Modifier Low / Median / High Price $40.00 / $91.00 / $161.00	Facility		$40.00	$91.00	$161.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $68.94 / $88.15 / $208.44	Professional		$68.94	$88.15	$208.44
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $42.09 / $57.87 / $96.68	Professional		$42.09	$57.87	$96.68
United Facility/Professional Facility Modifier Low / Median / High Price $83.08 / $83.08 / $83.08	Facility		$83.08	$83.08	$83.08
United Facility/Professional Professional Modifier Low / Median / High Price $55.64 / $75.29 / $181.60	Professional		$55.64	$75.29	$181.60