Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $305.52 / $4,420.00 / $16,125.00	Facility		$305.52	$4,420.00	$16,125.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $131.71 / $147.30 / $1,039.41	Facility	54	$131.71	$147.30	$1,039.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $175.61 / $208.39 / $749.13	Professional		$175.61	$208.39	$749.13
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $124.94 / $156.29 / $817.59	Professional	54	$124.94	$156.29	$817.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $133.01 / $193.79 / $247.60	Professional		$133.01	$193.79	$247.60
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 $183.51 / $253.41 / $506.96	Professional		$183.51	$253.41	$506.96
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 $159.19 / $221.03 / $491.49	Professional		$159.19	$221.03	$491.49
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 $196.67 / $268.11 / $558.29	Professional		$196.67	$268.11	$558.29
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $138.66 / $264.58 / $357.18	Professional		$138.66	$264.58	$357.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $218.44 / $292.20 / $522.16	Professional		$218.44	$292.20	$522.16
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $55.00 / $998.32 / $1,110.50	Facility		$55.00	$998.32	$1,110.50
Lucent Health Facility/Professional Facility Modifier 54 Low / Median / High Price $681.37 / $777.35 / $777.35	Facility	54	$681.37	$777.35	$777.35
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,543.44 / $1,670.64 / $1,909.88	Professional		$1,543.44	$1,670.64	$1,909.88
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 $208.29 / $280.55 / $384.51	Facility		$208.29	$280.55	$384.51
Providence Facility/Professional Facility Modifier 54 Low / Median / High Price $245.76 / $245.76 / $418.20	Facility	54	$245.76	$245.76	$418.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $203.66 / $287.16 / $570.07	Professional		$203.66	$287.16	$570.07
Providence Facility/Professional Professional Modifier 54 Low / Median / High Price $322.89 / $344.30 / $2,352,000.00	Professional	54	$322.89	$344.30	$2,352,000.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $676.41 / $676.41 / $725.69	Professional		$676.41	$676.41	$725.69
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $155.30 / $235.72 / $313.39	Professional		$155.30	$235.72	$313.39
United Facility/Professional Facility Modifier Low / Median / High Price $526.00 / $1,506.00 / $5,830.00	Facility		$526.00	$1,506.00	$5,830.00
United Facility/Professional Professional Modifier Low / Median / High Price $169.02 / $219.10 / $515.59	Professional		$169.02	$219.10	$515.59