Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $115.25 / $207.76 / $469.97	Facility		$115.25	$207.76	$469.97
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $77.62 / $289.00 / $981.00	Facility	25	$77.62	$289.00	$981.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.64 / $187.94 / $513.00	Professional		$95.64	$187.94	$513.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $117.33 / $224.89 / $538.50	Professional	25	$117.33	$224.89	$538.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $136.74 / $190.22 / $446.99	Professional		$136.74	$190.22	$446.99
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $154.02 / $182.90 / $350.00	Professional	25	$154.02	$182.90	$350.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $96.72 / $112.23 / $127.10	Facility		$96.72	$112.23	$127.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $105.14 / $149.29 / $264.19	Professional		$105.14	$149.29	$264.19
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 $93.51 / $134.88 / $316.85	Professional		$93.51	$134.88	$316.85
Cigna Facility/Professional Facility Modifier Low / Median / High Price $130.00 / $155.00 / $216.50	Facility		$130.00	$155.00	$216.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.16 / $169.63 / $364.67	Professional		$111.16	$169.63	$364.67
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $57.20 / $160.31 / $256.50	Professional		$57.20	$160.31	$256.50
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $192.52 / $271.33 / $714.16	Professional		$192.52	$271.33	$714.16
HealthNet Facility/Professional Professional Modifier 25 Low / Median / High Price $174.28 / $174.28 / $400.06	Professional	25	$174.28	$174.28	$400.06
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $143.15 / $201.56 / $347.80	Professional		$143.15	$201.56	$347.80
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $566.79 / $649.44 / $705.38	Facility		$566.79	$649.44	$705.38
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $901.73 / $901.73 / $1,127.38	Professional		$901.73	$901.73	$1,127.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $257.22	Professional		$32.34	$32.34	$257.22
Optum Facility/Professional Professional Modifier Low / Median / High Price $155.94 / $183.96 / $396.14	Professional		$155.94	$183.96	$396.14
Providence Facility/Professional Facility Modifier Low / Median / High Price $102.53 / $175.16 / $265.80	Facility		$102.53	$175.16	$265.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $111.37 / $185.54 / $400.19	Professional		$111.37	$185.54	$400.19
Sutter Health Plus Facility/Professional Facility Modifier Low / Median / High Price $162.00 / $175.00 / $319.00	Facility		$162.00	$175.00	$319.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $160.60 / $188.94 / $396.14	Professional		$160.60	$188.94	$396.14
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $85.80 / $178.08 / $236.29	Professional		$85.80	$178.08	$236.29
United Facility/Professional Facility Modifier Low / Median / High Price $207.50 / $207.50 / $207.50	Facility		$207.50	$207.50	$207.50
United Facility/Professional Professional Modifier Low / Median / High Price $111.25 / $149.29 / $346.35	Professional		$111.25	$149.29	$346.35