Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,546.09 / $10,230.00 / $22,788.00	Facility		$3,546.09	$10,230.00	$22,788.00
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 $66.90 / $100.00 / $15,838.91	Facility		$66.90	$100.00	$15,838.91
Cigna Facility/Professional Facility Modifier Low / Median / High Price $633.00 / $1,971.38 / $13,577.00	Facility		$633.00	$1,971.38	$13,577.00
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $1,205.60 / $1,205.60 / $1,205.60	Facility	62	$1,205.60	$1,205.60	$1,205.60
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $192.90 / $192.90 / $192.90	Facility	AS	$192.90	$192.90	$192.90
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $1,430.00 / $1,825.44 / $2,373.07	Professional		$1,430.00	$1,825.44	$2,373.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,562.43 / $2,037.86 / $3,819.27	Professional		$1,562.43	$2,037.86	$3,819.27
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $314.52 / $314.52 / $500.00	Professional	80	$314.52	$314.52	$500.00
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $314.52 / $314.52 / $314.52	Professional	AS	$314.52	$314.52	$314.52
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $4,100.00 / $12,863.04 / $22,189.40	Facility		$4,100.00	$12,863.04	$22,189.40
Lucent Health Facility/Professional Facility Modifier 62 Low / Median / High Price $2,382.09 / $13,156.44 / $13,156.44	Facility	62	$2,382.09	$13,156.44	$13,156.44
Lucent Health Facility/Professional Facility Modifier AS Low / Median / High Price $381.13 / $2,105.03 / $2,105.03	Facility	AS	$381.13	$2,105.03	$2,105.03
Providence Facility/Professional Facility Modifier Low / Median / High Price $1,630.29 / $2,083.23 / $2,941.52	Facility		$1,630.29	$2,083.23	$2,941.52
Providence Facility/Professional Facility Modifier 62 Low / Median / High Price $1,205.60 / $1,205.60 / $2,585.16	Facility	62	$1,205.60	$1,205.60	$2,585.16
Providence Facility/Professional Facility Modifier 80 Low / Median / High Price $661.80 / $661.80 / $661.80	Facility	80	$661.80	$661.80	$661.80
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $192.90 / $192.90 / $562.53	Facility	AS	$192.90	$192.90	$562.53
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