Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $91.20 / $354.81	Facility		$38.02	$91.20	$354.81
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $91.20 / $194.98 / $416.87	Facility	25	$91.20	$194.98	$416.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $57.54 / $147.91	Professional		$32.36	$57.54	$147.91
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $33.88 / $61.66 / $147.91	Professional	25	$33.88	$61.66	$147.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $54.95 / $83.18	Professional		$32.36	$54.95	$83.18
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $43.65 / $56.23 / $79.43	Professional	25	$43.65	$56.23	$79.43
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $54.95 / $54.95 / $54.95	Professional	50	$54.95	$54.95	$54.95
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $28.84 / $35.48 / $39.81	Facility		$28.84	$35.48	$39.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $47.86 / $77.62	Professional		$29.51	$47.86	$77.62
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 $42.66 / $58.88 / $117.49	Professional		$42.66	$58.88	$117.49
Cigna Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $147.91 / $223.87	Facility		$67.61	$147.91	$223.87
Cigna Facility/Professional Facility Modifier 22 Low / Median / High Price $64.57 / $64.57 / $64.57	Facility	22	$64.57	$64.57	$64.57
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $33.88 / $33.88 / $33.88	Facility	62	$33.88	$33.88	$33.88
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $5.37 / $5.37 / $5.37	Facility	AS	$5.37	$5.37	$5.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $50.12 / $97.72	Professional		$28.84	$50.12	$97.72
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $18.20 / $34.67 / $89.13	Professional		$18.20	$34.67	$89.13
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $66.07 / $109.65	Professional		$54.95	$66.07	$109.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $58.88 / $100.00	Professional		$30.90	$58.88	$100.00
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $223.87 / $223.87 / $223.87	Facility		$223.87	$223.87	$223.87
Lucent Health Facility/Professional Facility Modifier 62 Low / Median / High Price $141.25 / $141.25 / $141.25	Facility	62	$141.25	$141.25	$141.25
Lucent Health Facility/Professional Facility Modifier AS Low / Median / High Price $22.39 / $22.39 / $22.39	Facility	AS	$22.39	$22.39	$22.39
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $117.49 / $354.81	Professional		$39.81	$117.49	$354.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $47.86 / $724.44	Professional		$19.95	$47.86	$724.44
Optum Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $66.07 / $104.71	Professional		$51.29	$66.07	$104.71
Providence Facility/Professional Facility Modifier Low / Median / High Price $27.54 / $47.86 / $87.10	Facility		$27.54	$47.86	$87.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $52.48 / $107.15	Professional		$28.84	$52.48	$107.15
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $66.07 / $120.23	Professional		$25.70	$66.07	$120.23
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $18.20 / $28.18 / $67.61	Professional		$18.20	$28.18	$67.61
United Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $46.77 / $52.48	Facility		$35.48	$46.77	$52.48
United Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $38.90 / $77.62	Professional		$22.39	$38.90	$77.62