Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $181.97 / $446.68	Facility		$112.20	$181.97	$446.68
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $162.18 / $354.81 / $446.68	Facility	25	$162.18	$354.81	$446.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $190.55 / $524.81	Professional		$123.03	$190.55	$524.81
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $125.89 / $204.17 / $549.54	Professional	25	$125.89	$204.17	$549.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $165.96 / $251.19	Professional		$117.49	$165.96	$251.19
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $134.90 / $169.82 / $263.03	Professional	25	$134.90	$169.82	$263.03
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $165.96 / $186.21	Facility		$134.90	$165.96	$186.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $169.82 / $275.42	Professional		$123.03	$169.82	$275.42
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 $154.88 / $204.17 / $398.11	Professional		$154.88	$204.17	$398.11
Cigna Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $151.36 / $223.87	Facility		$123.03	$151.36	$223.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $181.97 / $323.59	Professional		$128.82	$181.97	$323.59
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $128.82 / $251.19	Professional		$69.18	$128.82	$251.19
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $295.12 / $616.60	Professional		$199.53	$295.12	$616.60
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 $112.20 / $181.97 / $302.00	Professional		$112.20	$181.97	$302.00
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $831.76 / $831.76 / $831.76	Facility		$831.76	$831.76	$831.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $245.47 / $1,047.13	Professional		$144.54	$245.47	$1,047.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $144.54 / $239.88	Professional		$75.86	$144.54	$239.88
Optum Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $190.55 / $269.15	Professional		$147.91	$190.55	$269.15
Providence Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $173.78 / $275.42	Facility		$112.20	$173.78	$275.42
Providence Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $186.21 / $354.81	Professional		$128.82	$186.21	$354.81
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $331.13 / $426.58	Professional		$75.86	$331.13	$426.58
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $104.71 / $194.98	Professional		$69.18	$104.71	$194.98
United Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $131.83 / $204.17	Facility		$69.18	$131.83	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $151.36 / $281.84	Professional		$107.15	$151.36	$281.84