Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.58 / $104.34 / $199.92	Professional		$74.58	$104.34	$199.92
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $113.82 / $113.82 / $113.82	Professional		$113.82	$113.82	$113.82
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $10.74 / $11.90 / $278.79	Facility		$10.74	$11.90	$278.79
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $119.00 / $164.80 / $234.58	Professional		$119.00	$164.80	$234.58
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $288.26 / $288.26 / $288.26	Facility		$288.26	$288.26	$288.26
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $100.00 / $193.43	Professional		$100.00	$100.00	$193.43
Cigna Facility/Professional Facility Modifier Low / Median / High Price $129.12 / $129.12 / $193.43	Facility		$129.12	$129.12	$193.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.75 / $129.12 / $205.20	Professional		$109.75	$129.12	$205.20
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $133.69 / $133.69 / $160.44	Professional		$133.69	$133.69	$160.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $168.00 / $192.07 / $801.00	Professional		$168.00	$192.07	$801.00
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $202.94 / $911.54 / $944.78	Facility		$202.94	$911.54	$944.78
Providence Facility/Professional Facility Modifier Low / Median / High Price $24.34 / $117.00 / $226.05	Facility		$24.34	$117.00	$226.05
Providence Facility/Professional Professional Modifier Low / Median / High Price $109.75 / $129.12 / $189.01	Professional		$109.75	$129.12	$189.01
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $133.69 / $133.69 / $133.69	Professional		$133.69	$133.69	$133.69
United Facility/Professional Professional Modifier Low / Median / High Price $80.33 / $93.60 / $186.57	Professional		$80.33	$93.60	$186.57