Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,174.90 / $3,467.37 / $5,754.40	Facility		$1,174.90	$3,467.37	$5,754.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $691.83 / $831.76	Professional		$562.34	$691.83	$831.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $281.84 / $281.84	Professional		$281.84	$281.84	$281.84
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,137.96 / $4,168.69 / $4,265.80	Facility		$2,137.96	$4,168.69	$4,265.80
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $407.38 / $1,288.25	Professional		$338.84	$407.38	$1,288.25
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $1,949.84 / $8,128.31	Facility		$69.18	$1,949.84	$8,128.31
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $630.96 / $1,548.82	Professional		$489.78	$630.96	$1,548.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $562.34 / $1,096.48 / $2,691.53	Facility		$562.34	$1,096.48	$2,691.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $1,023.29 / $1,288.25	Professional		$602.56	$1,023.29	$1,288.25
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $831.76 / $1,000.00	Professional		$100.00	$831.76	$1,000.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $831.76 / $1,479.11	Professional		$676.08	$831.76	$1,479.11
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $3,981.07 / $3,981.07 / $3,981.07	Facility		$3,981.07	$3,981.07	$3,981.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $19.95 / $19.95	Professional		$19.95	$19.95	$19.95
Providence Facility/Professional Facility Modifier Low / Median / High Price $501.19 / $831.76 / $2,089.30	Facility		$501.19	$831.76	$2,089.30
Providence Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $831.76 / $831.76	Professional		$602.56	$831.76	$831.76
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $851.14 / $1,445.44	Professional		$676.08	$851.14	$1,445.44
United Facility/Professional Facility Modifier Low / Median / High Price $354.81 / $457.09 / $831.76	Facility		$354.81	$457.09	$831.76
United Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $380.19 / $1,513.56	Professional		$354.81	$380.19	$1,513.56