Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $226.23 / $4,075.00 / $16,109.00	Facility		$226.23	$4,075.00	$16,109.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $122.99 / $135.08 / $936.29	Facility	54	$122.99	$135.08	$936.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $161.96 / $197.36 / $640.94	Professional		$161.96	$197.36	$640.94
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $114.38 / $145.47 / $740.87	Professional	54	$114.38	$145.47	$740.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $298.33 / $298.33 / $298.33	Professional		$298.33	$298.33	$298.33
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,723.00 / $4,464.00 / $8,976.00	Facility		$1,723.00	$4,464.00	$8,976.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $188.67 / $241.77 / $487.90	Professional		$188.67	$241.77	$487.90
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $66.00 / $100.00 / $1,581.82	Facility		$66.00	$100.00	$1,581.82
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $133.08 / $190.11 / $416.08	Professional		$133.08	$190.11	$416.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $56.00 / $253.20 / $453.49	Facility		$56.00	$253.20	$453.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $177.25 / $238.40 / $504.79	Professional		$177.25	$238.40	$504.79
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $73.68 / $247.82 / $334.56	Professional		$73.68	$247.82	$334.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $204.69 / $274.13 / $486.00	Professional		$204.69	$274.13	$486.00
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $55.00 / $930.88 / $1,041.68	Facility		$55.00	$930.88	$1,041.68
Lucent Health Facility/Professional Facility Modifier 54 Low / Median / High Price $641.12 / $729.18 / $729.18	Facility	54	$641.12	$729.18	$729.18
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,439.44 / $1,554.96 / $1,820.18	Professional		$1,439.44	$1,554.96	$1,820.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $32.34	Professional		$32.34	$32.34	$32.34
Providence Facility/Professional Facility Modifier Low / Median / High Price $181.71 / $262.18 / $357.09	Facility		$181.71	$262.18	$357.09
Providence Facility/Professional Facility Modifier 54 Low / Median / High Price $230.60 / $230.60 / $386.73	Facility	54	$230.60	$230.60	$386.73
Providence Facility/Professional Professional Modifier Low / Median / High Price $180.46 / $251.17 / $523.12	Professional		$180.46	$251.17	$523.12
Providence Facility/Professional Professional Modifier 54 Low / Median / High Price $298.58 / $343.34 / $2,352,000.00	Professional	54	$298.58	$343.34	$2,352,000.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $612.94 / $612.94 / $653.80	Professional		$612.94	$612.94	$653.80
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $82.52 / $214.69 / $295.20	Professional		$82.52	$214.69	$295.20
United Facility/Professional Facility Modifier Low / Median / High Price $548.00 / $1,533.00 / $6,323.00	Facility		$548.00	$1,533.00	$6,323.00
United Facility/Professional Professional Modifier Low / Median / High Price $151.74 / $200.35 / $445.28	Professional		$151.74	$200.35	$445.28