Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $4,604.00 / $15,627.33 / $49,858.16	Facility		$4,604.00	$15,627.33	$49,858.16
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $21,520.00 / $21,520.00 / $21,520.00	Facility	22	$21,520.00	$21,520.00	$21,520.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $8,133.15 / $32,375.09 / $64,159.06	Facility	50	$8,133.15	$32,375.09	$64,159.06
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $988.46 / $1,048.11 / $5,917.28	Facility	54	$988.46	$1,048.11	$5,917.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,171.91 / $1,554.19 / $6,045.33	Professional		$1,171.91	$1,554.19	$6,045.33
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $158.15 / $398.02 / $1,053.55	Professional	AS	$158.15	$398.02	$1,053.55
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,162.27 / $1,342.13 / $2,093.30	Professional		$1,162.27	$1,342.13	$2,093.30
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,940.00 / $10,165.00 / $26,317.00	Facility		$3,940.00	$10,165.00	$26,317.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,584.09 / $2,237.48 / $4,148.32	Professional		$1,584.09	$2,237.48	$4,148.32
Anthem BCBS Facility/Professional Professional Modifier AS Low / Median / High Price $172.02 / $210.68 / $289.07	Professional	AS	$172.02	$210.68	$289.07
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $65.90 / $100.00 / $9,470.12	Facility		$65.90	$100.00	$9,470.12
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $1,114.13 / $1,594.69 / $3,485.01	Professional		$1,114.13	$1,594.69	$3,485.01
Cigna Facility/Professional Facility Modifier Low / Median / High Price $8,000.00 / $18,556.49 / $33,235.51	Facility		$8,000.00	$18,556.49	$33,235.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,354.38 / $1,730.60 / $3,619.88	Professional		$1,354.38	$1,730.60	$3,619.88
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $1,451.32 / $1,596.45 / $2,817.00	Professional		$1,451.32	$1,596.45	$2,817.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,185.25 / $1,645.68 / $2,983.54	Professional		$1,185.25	$1,645.68	$2,983.54
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $10,780.38 / $25,000.00 / $53,594.95	Facility		$10,780.38	$25,000.00	$53,594.95
Lucent Health Facility/Professional Facility Modifier 54 Low / Median / High Price $2,023.31 / $35,560.28 / $35,560.28	Facility	54	$2,023.31	$35,560.28	$35,560.28
Lucent Health Facility/Professional Facility Modifier 62 Low / Median / High Price $1,806.53 / $31,750.25 / $31,750.25	Facility	62	$1,806.53	$31,750.25	$31,750.25
Lucent Health Facility/Professional Facility Modifier AS Low / Median / High Price $289.04 / $5,080.04 / $5,080.04	Facility	AS	$289.04	$5,080.04	$5,080.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $13,550.61 / $13,550.61 / $13,550.61	Professional		$13,550.61	$13,550.61	$13,550.61
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 $1,371.85 / $1,744.77 / $2,868.94	Facility		$1,371.85	$1,744.77	$2,868.94
Providence Facility/Professional Facility Modifier 54 Low / Median / High Price $1,008.15 / $1,008.15 / $2,442.41	Facility	54	$1,008.15	$1,008.15	$2,442.41
Providence Facility/Professional Facility Modifier 62 Low / Median / High Price $900.13 / $900.13 / $1,908.13	Facility	62	$900.13	$900.13	$1,908.13
Providence Facility/Professional Facility Modifier 80 Low / Median / High Price $488.48 / $488.48 / $488.48	Facility	80	$488.48	$488.48	$488.48
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $144.02 / $144.02 / $415.21	Facility	AS	$144.02	$144.02	$415.21
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,354.38 / $1,766.69 / $3,555.77	Professional		$1,354.38	$1,766.69	$3,555.77
Providence Facility/Professional Professional Modifier AS Low / Median / High Price $325.76 / $366.61 / $399,840.00	Professional	AS	$325.76	$366.61	$399,840.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $4,381.39 / $4,381.39 / $4,381.39	Professional		$4,381.39	$4,381.39	$4,381.39
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $1,306.52 / $1,610.00 / $2,817.00	Professional		$1,306.52	$1,610.00	$2,817.00
United Facility/Professional Facility Modifier Low / Median / High Price $9,710.00 / $18,646.00 / $41,890.00	Facility		$9,710.00	$18,646.00	$41,890.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,089.59 / $1,450.77 / $2,981.73	Professional		$1,089.59	$1,450.77	$2,981.73