Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $227.28 / $454.20 / $1,108.44	Facility		$227.28	$454.20	$1,108.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $227.28 / $229.37 / $454.20	Professional		$227.28	$229.37	$454.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $361.38 / $361.38 / $361.38	Professional		$361.38	$361.38	$361.38
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $241.12 / $363.03 / $813.80	Facility		$241.12	$363.03	$813.80
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $227.10 / $235.68 / $481.45	Professional		$227.10	$235.68	$481.45
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $77.70 / $100.00 / $291.48	Facility		$77.70	$100.00	$291.48
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $231.57 / $231.57 / $487.96	Professional		$231.57	$231.57	$487.96
Cigna Facility/Professional Facility Modifier Low / Median / High Price $214.41 / $214.41 / $227.28	Facility		$214.41	$214.41	$227.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $227.28 / $227.28 / $278.74	Professional		$227.28	$227.28	$278.74
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $221.71 / $224.09 / $302.52	Professional		$221.71	$224.09	$302.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $204.55 / $272.74 / $454.56	Professional		$204.55	$272.74	$454.56
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $294.92 / $1,108.55 / $1,136.40	Facility		$294.92	$1,108.55	$1,136.40
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $9,490.31 / $9,490.31 / $9,490.31	Professional		$9,490.31	$9,490.31	$9,490.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $60.00 / $459.38 / $459.38	Professional		$60.00	$459.38	$459.38
Providence Facility/Professional Facility Modifier Low / Median / High Price $211.67 / $227.28 / $371.97	Facility		$211.67	$227.28	$371.97
Providence Facility/Professional Professional Modifier Low / Median / High Price $227.28 / $227.28 / $284.82	Professional		$227.28	$227.28	$284.82
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $323.08 / $323.08 / $323.08	Professional		$323.08	$323.08	$323.08
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $181.82 / $227.28 / $340.92	Professional		$181.82	$227.28	$340.92
United Facility/Professional Facility Modifier Low / Median / High Price $227.28 / $227.28 / $227.28	Facility		$227.28	$227.28	$227.28
United Facility/Professional Professional Modifier Low / Median / High Price $227.28 / $227.28 / $388.83	Professional		$227.28	$227.28	$388.83