Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $131.83 / $239.88	Facility		$83.18	$131.83	$239.88
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $128.82 / $208.93 / $371.54	Facility	25	$128.82	$208.93	$371.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $128.82 / $363.08	Professional		$77.62	$128.82	$363.08
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $77.62 / $131.83 / $346.74	Professional	25	$77.62	$131.83	$346.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $112.20 / $169.82	Professional		$77.62	$112.20	$169.82
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $89.13 / $112.20 / $173.78	Professional	25	$89.13	$112.20	$173.78
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $79.43 / $97.72 / $109.65	Facility		$79.43	$97.72	$109.65
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $112.20 / $181.97	Professional		$75.86	$112.20	$181.97
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $83.18 / $91.20	Facility		$83.18	$83.18	$91.20
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $141.25 / $269.15	Professional		$107.15	$141.25	$269.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $147.91 / $223.87	Facility		$123.03	$147.91	$223.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $120.23 / $213.80	Professional		$81.28	$120.23	$213.80
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $79.43 / $173.78	Professional		$57.54	$79.43	$173.78
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $194.98 / $407.38	Professional		$112.20	$194.98	$407.38
HealthNet Facility/Professional Professional Modifier 25 Low / Median / High Price $194.98 / $194.98 / $199.53	Professional	25	$194.98	$194.98	$199.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $117.49 / $199.53	Professional		$70.79	$117.49	$199.53
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $512.86 / $512.86 / $512.86	Facility		$512.86	$512.86	$512.86
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $177.83 / $691.83	Professional		$100.00	$177.83	$691.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $77.62 / $158.49	Professional		$44.67	$77.62	$158.49
Optum Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $123.03 / $181.97	Professional		$95.50	$123.03	$181.97
Providence Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $112.20 / $181.97	Facility		$69.18	$112.20	$181.97
Providence Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $123.03 / $229.09	Professional		$81.28	$123.03	$229.09
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $194.98 / $281.84	Professional		$54.95	$194.98	$281.84
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $72.44 / $131.83	Professional		$57.54	$72.44	$131.83
United Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $93.33 / $134.90	Facility		$69.18	$93.33	$134.90
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $97.72 / $177.83	Professional		$64.57	$97.72	$177.83