Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,706.00 / $10,143.00 / $22,788.00	Facility		$3,706.00	$10,143.00	$22,788.00
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $14,696.00 / $14,696.00 / $14,696.00	Facility	22	$14,696.00	$14,696.00	$14,696.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,434.00 / $11,689.00 / $24,301.00	Facility		$3,434.00	$11,689.00	$24,301.00
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $67.90 / $100.00 / $13,259.86	Facility		$67.90	$100.00	$13,259.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $633.00 / $1,749.72 / $14,932.00	Facility		$633.00	$1,749.72	$14,932.00
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $1,070.46 / $1,070.46 / $1,070.46	Facility	62	$1,070.46	$1,070.46	$1,070.46
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $171.27 / $171.27 / $171.27	Facility	AS	$171.27	$171.27	$171.27
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $1,272.52 / $1,621.98 / $2,108.57	Professional		$1,272.52	$1,621.98	$2,108.57
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,387.29 / $1,809.25 / $3,405.62	Professional		$1,387.29	$1,809.25	$3,405.62
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $280.11 / $280.11 / $500.00	Professional	80	$280.11	$280.11	$500.00
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $280.12 / $280.12 / $280.12	Professional	AS	$280.12	$280.12	$280.12
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $3,250.00 / $11,410.96 / $22,189.40	Facility		$3,250.00	$11,410.96	$22,189.40
Lucent Health Facility/Professional Facility Modifier 62 Low / Median / High Price $2,112.55 / $13,156.44 / $13,156.44	Facility	62	$2,112.55	$13,156.44	$13,156.44
Lucent Health Facility/Professional Facility Modifier AS Low / Median / High Price $338.01 / $2,105.03 / $2,105.03	Facility	AS	$338.01	$2,105.03	$2,105.03
Providence Facility/Professional Facility Modifier Low / Median / High Price $1,447.40 / $1,849.72 / $2,617.54	Facility		$1,447.40	$1,849.72	$2,617.54
Providence Facility/Professional Facility Modifier 62 Low / Median / High Price $1,070.46 / $1,070.46 / $2,299.59	Facility	62	$1,070.46	$1,070.46	$2,299.59
Providence Facility/Professional Facility Modifier 80 Low / Median / High Price $588.70 / $588.70 / $588.70	Facility	80	$588.70	$588.70	$588.70
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $171.27 / $171.27 / $500.39	Facility	AS	$171.27	$171.27	$500.39
United Facility/Professional Facility Modifier Low / Median / High Price $4,169.00 / $13,205.00 / $29,312.00	Facility		$4,169.00	$13,205.00	$29,312.00