Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $84.91 / $127.54 / $239.40	Facility		$84.91	$127.54	$239.40
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $163.80 / $210.83 / $276.77	Facility	25	$163.80	$210.83	$276.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $78.98 / $126.29 / $365.00	Professional		$78.98	$126.29	$365.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $81.00 / $133.90 / $369.36	Professional	25	$81.00	$133.90	$369.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $82.81 / $114.02 / $250.25	Professional		$82.81	$114.02	$250.25
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $95.74 / $114.02 / $217.03	Professional	25	$95.74	$114.02	$217.03
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $79.95 / $92.79 / $105.08	Facility		$79.95	$92.79	$105.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.95 / $112.79 / $203.32	Professional		$79.95	$112.79	$203.32
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 $86.76 / $122.87 / $277.02	Professional		$86.76	$122.87	$277.02
Cigna Facility/Professional Facility Modifier Low / Median / High Price $120.00 / $150.00 / $180.00	Facility		$120.00	$150.00	$180.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.06 / $117.77 / $236.35	Professional		$75.06	$117.77	$236.35
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $57.20 / $99.31 / $161.00	Professional		$57.20	$99.31	$161.00
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $119.68 / $163.98 / $202.21	Professional		$119.68	$163.98	$202.21
HealthNet Facility/Professional Professional Modifier 25 Low / Median / High Price $195.00 / $195.00 / $200.00	Professional	25	$195.00	$195.00	$200.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $81.48 / $119.72 / $213.00	Professional		$81.48	$119.72	$213.00
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $220.00 / $399.71 / $399.71	Facility		$220.00	$399.71	$399.71
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $514.87 / $699.27 / $699.27	Professional		$514.87	$699.27	$699.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $95.23	Professional		$32.34	$32.34	$95.23
Optum Facility/Professional Professional Modifier Low / Median / High Price $100.71 / $124.12 / $300.25	Professional		$100.71	$124.12	$300.25
Providence Facility/Professional Facility Modifier Low / Median / High Price $73.09 / $111.29 / $167.30	Facility		$73.09	$111.29	$167.30
Providence Facility/Professional Professional Modifier Low / Median / High Price $76.79 / $128.22 / $264.19	Professional		$76.79	$128.22	$264.19
Sutter Health Plus Facility/Professional Facility Modifier Low / Median / High Price $98.00 / $165.00 / $299.94	Facility		$98.00	$165.00	$299.94
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $102.00 / $130.51 / $299.94	Professional		$102.00	$130.51	$299.94
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $72.90 / $100.24 / $147.22	Professional		$72.90	$100.24	$147.22
United Facility/Professional Facility Modifier Low / Median / High Price $128.25 / $128.25 / $128.25	Facility		$128.25	$128.25	$128.25
United Facility/Professional Professional Modifier Low / Median / High Price $81.81 / $109.22 / $266.99	Professional		$81.81	$109.22	$266.99