Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $62.80 / $119.14 / $296.95	Facility		$62.80	$119.14	$296.95
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $163.74 / $275.00 / $469.92	Facility	25	$163.74	$275.00	$469.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.02 / $93.65 / $239.54	Professional		$56.02	$93.65	$239.54
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $54.57 / $97.13 / $252.15	Professional	25	$54.57	$97.13	$252.15
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $254.64 / $262.68 / $271.76	Professional	50	$254.64	$262.68	$271.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $60.00 / $88.37 / $154.37	Professional		$60.00	$88.37	$154.37
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $74.59 / $92.24 / $178.25	Professional	25	$74.59	$92.24	$178.25
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $55.43 / $64.31 / $72.84	Facility		$55.43	$64.31	$72.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $55.43 / $80.00 / $135.22	Professional		$55.43	$80.00	$135.22
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 $59.03 / $85.52 / $196.86	Professional		$59.03	$85.52	$196.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $109.05 / $150.00 / $180.00	Facility		$109.05	$150.00	$180.00
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $55.05 / $55.05 / $55.05	Facility	62	$55.05	$55.05	$55.05
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $8.81 / $8.81 / $8.81	Facility	AS	$8.81	$8.81	$8.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $49.62 / $83.69 / $180.96	Professional		$49.62	$83.69	$180.96
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $24.00 / $73.34 / $130.97	Professional		$24.00	$73.34	$130.97
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $93.29 / $122.25 / $280.82	Professional		$93.29	$122.25	$280.82
HealthNet Facility/Professional Professional Modifier 25 Low / Median / High Price $98.10 / $98.10 / $193.46	Professional	25	$98.10	$98.10	$193.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.02 / $98.24 / $171.83	Professional		$66.02	$98.24	$171.83
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $220.00 / $323.29 / $323.29	Facility		$220.00	$323.29	$323.29
Lucent Health Facility/Professional Facility Modifier 62 Low / Median / High Price $186.38 / $202.06 / $202.06	Facility	62	$186.38	$202.06	$202.06
Lucent Health Facility/Professional Facility Modifier AS Low / Median / High Price $29.82 / $32.33 / $32.33	Facility	AS	$29.82	$32.33	$32.33
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $199.03 / $413.45 / $567.54	Professional		$199.03	$413.45	$567.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $128.91	Professional		$32.34	$32.34	$128.91
Optum Facility/Professional Professional Modifier Low / Median / High Price $77.70 / $95.36 / $210.05	Professional		$77.70	$95.36	$210.05
Providence Facility/Professional Facility Modifier Low / Median / High Price $43.95 / $81.73 / $134.38	Facility		$43.95	$81.73	$134.38
Providence Facility/Professional Facility Modifier 62 Low / Median / High Price $55.05 / $55.05 / $55.05	Facility	62	$55.05	$55.05	$55.05
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $8.81 / $8.81 / $8.81	Facility	AS	$8.81	$8.81	$8.81
Providence Facility/Professional Professional Modifier Low / Median / High Price $52.23 / $90.58 / $197.60	Professional		$52.23	$90.58	$197.60
Providence Facility/Professional Professional Modifier 25 Low / Median / High Price $41.00 / $41.00 / $41.00	Professional	25	$41.00	$41.00	$41.00
Sutter Health Plus Facility/Professional Facility Modifier Low / Median / High Price $80.00 / $90.00 / $166.00	Facility		$80.00	$90.00	$166.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $80.00 / $97.23 / $202.99	Professional		$80.00	$97.23	$202.99
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $36.00 / $81.48 / $121.31	Professional		$36.00	$81.48	$121.31
United Facility/Professional Facility Modifier Low / Median / High Price $104.51 / $104.51 / $104.51	Facility		$104.51	$104.51	$104.51
United Facility/Professional Professional Modifier Low / Median / High Price $55.88 / $75.95 / $183.99	Professional		$55.88	$75.95	$183.99