Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $467.74 / $660.69	Facility		$107.15	$467.74	$660.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $162.18 / $512.86	Professional		$107.15	$162.18	$512.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $154.88 / $181.97	Professional		$131.83	$154.88	$181.97
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $147.91 / $165.96	Facility		$120.23	$147.91	$165.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $162.18 / $281.84	Professional		$117.49	$162.18	$281.84
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 $165.96 / $218.78 / $426.58	Professional		$165.96	$218.78	$426.58
Cigna Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $107.15 / $190.55	Facility		$107.15	$107.15	$190.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $177.83 / $331.13	Professional		$120.23	$177.83	$331.13
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $144.54 / $186.21	Professional		$114.82	$144.54	$186.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $173.78 / $288.40	Professional		$107.15	$173.78	$288.40
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $776.25 / $776.25 / $776.25	Facility		$776.25	$776.25	$776.25
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $1,023.29 / $1,023.29	Professional		$1,023.29	$1,023.29	$1,023.29
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $229.09	Professional		$32.36	$33.11	$229.09
Providence Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $162.18 / $269.15	Facility		$104.71	$162.18	$269.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $181.97 / $346.74	Professional		$120.23	$181.97	$346.74
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $169.82 / $229.09	Professional		$109.65	$169.82	$229.09
United Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $141.25 / $141.25	Facility		$141.25	$141.25	$141.25
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $147.91 / $275.42	Professional		$100.00	$147.91	$275.42