Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $144.47 / $217.15 / $570.46	Facility		$144.47	$217.15	$570.46
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $75.00 / $75.00 / $531.90	Facility	25	$75.00	$75.00	$531.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.84 / $253.01 / $725.00	Professional		$151.84	$253.01	$725.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $166.73 / $289.87 / $781.35	Professional	25	$166.73	$289.87	$781.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $181.93 / $234.86 / $671.24	Professional		$181.93	$234.86	$671.24
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $187.89 / $223.12 / $505.49	Professional	25	$187.89	$223.12	$505.49
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $174.80 / $202.84 / $229.70	Facility		$174.80	$202.84	$229.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $164.72 / $223.11 / $407.13	Professional		$164.72	$223.11	$407.13
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $91.00 / $115.00 / $303.07	Facility		$91.00	$115.00	$303.07
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $127.81 / $198.92 / $451.62	Professional		$127.81	$198.92	$451.62
Cigna Facility/Professional Facility Modifier Low / Median / High Price $130.00 / $155.00 / $242.44	Facility		$130.00	$155.00	$242.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.86 / $237.20 / $483.95	Professional		$162.86	$237.20	$483.95
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $82.70 / $201.05 / $309.56	Professional		$82.70	$201.05	$309.56
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $273.54 / $632.72 / $632.72	Professional		$273.54	$632.72	$632.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $180.82 / $247.13 / $420.14	Professional		$180.82	$247.13	$420.14
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $419.92 / $888.06 / $888.06	Facility		$419.92	$888.06	$888.06
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,134.11 / $1,377.15 / $1,377.15	Professional		$1,134.11	$1,377.15	$1,377.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $189.20	Professional		$32.34	$32.34	$189.20
Optum Facility/Professional Professional Modifier Low / Median / High Price $195.75 / $243.24 / $560.15	Professional		$195.75	$243.24	$560.15
Providence Facility/Professional Facility Modifier Low / Median / High Price $145.11 / $225.00 / $333.02	Facility		$145.11	$225.00	$333.02
Providence Facility/Professional Professional Modifier Low / Median / High Price $163.52 / $255.63 / $517.02	Professional		$163.52	$255.63	$517.02
Sutter Health Plus Facility/Professional Facility Modifier Low / Median / High Price $173.00 / $202.00 / $449.00	Facility		$173.00	$202.00	$449.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $198.81 / $256.85 / $560.15	Professional		$198.81	$256.85	$560.15
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $124.05 / $223.26 / $286.56	Professional		$124.05	$223.26	$286.56
United Facility/Professional Facility Modifier Low / Median / High Price $253.44 / $253.44 / $253.44	Facility		$253.44	$253.44	$253.44
United Facility/Professional Professional Modifier Low / Median / High Price $154.66 / $211.12 / $489.01	Professional		$154.66	$211.12	$489.01
United Facility/Professional Professional Modifier 25 Low / Median / High Price $80.00 / $80.00 / $88.00	Professional	25	$80.00	$80.00	$88.00