Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $927.00 / $4,704.00 / $16,125.00	Facility		$927.00	$4,704.00	$16,125.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $178.86 / $192.36 / $1,212.13	Facility	52	$178.86	$192.36	$1,212.13
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $268.29 / $288.54 / $1,818.20	Facility	54	$268.29	$288.54	$1,818.20
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
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $66.00 / $100.00 / $5,367.09	Facility		$66.00	$100.00	$5,367.09
Cigna Facility/Professional Facility Modifier Low / Median / High Price $253.20 / $253.65 / $1,487.00	Facility		$253.20	$253.65	$1,487.00
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $348.10 / $506.40 / $658.47	Professional		$348.10	$506.40	$658.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $412.89 / $571.25 / $1,009.29	Professional		$412.89	$571.25	$1,009.29
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $973.25 / $2,179.16 / $12,000.00	Facility		$973.25	$2,179.16	$12,000.00
Lucent Health Facility/Professional Facility Modifier 52 Low / Median / High Price $666.84 / $1,575.58 / $1,743.33	Facility	52	$666.84	$1,575.58	$1,743.33
Lucent Health Facility/Professional Facility Modifier 54 Low / Median / High Price $583.48 / $1,378.64 / $1,525.41	Facility	54	$583.48	$1,378.64	$1,525.41
Providence Facility/Professional Facility Modifier Low / Median / High Price $393.22 / $534.51 / $735.68	Facility		$393.22	$534.51	$735.68
Providence Facility/Professional Facility Modifier 52 Low / Median / High Price $384.75 / $384.75 / $384.75	Facility	52	$384.75	$384.75	$384.75
Providence Facility/Professional Facility Modifier 54 Low / Median / High Price $336.66 / $336.66 / $788.86	Facility	54	$336.66	$336.66	$788.86
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