Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,211.51 / $9,665.00 / $22,788.00	Facility		$1,211.51	$9,665.00	$22,788.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $516.76 / $605.76 / $3,443.62	Facility	52	$516.76	$605.76	$3,443.62
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $206.70 / $242.30 / $1,377.45	Facility	53	$206.70	$242.30	$1,377.45
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,873.70 / $8,947.00 / $19,298.00	Facility		$2,873.70	$8,947.00	$19,298.00
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $63.90 / $100.00 / $5,487.90	Facility		$63.90	$100.00	$5,487.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $633.00 / $766.00 / $5,431.00	Facility		$633.00	$766.00	$5,431.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $1,091.32 / $1,091.32 / $1,091.32	Facility	52	$1,091.32	$1,091.32	$1,091.32
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $272.83 / $272.83 / $272.83	Facility	53	$272.83	$272.83	$272.83
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $136.41 / $136.41 / $136.41	Facility	AS	$136.41	$136.41	$136.41
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $698.81 / $1,057.50 / $1,700.86	Professional		$698.81	$1,057.50	$1,700.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,113.52 / $1,451.85 / $2,675.73	Professional		$1,113.52	$1,451.85	$2,675.73
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $153.57 / $193.67 / $500.00	Professional	80	$153.57	$193.67	$500.00
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $153.57 / $153.57 / $193.67	Professional	AS	$153.57	$153.57	$193.67
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $55.00 / $11,004.64 / $11,255.12	Facility		$55.00	$11,004.64	$11,255.12
Lucent Health Facility/Professional Facility Modifier 52 Low / Median / High Price $1,902.63 / $4,456.67 / $4,701.51	Facility	52	$1,902.63	$4,456.67	$4,701.51
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $475.66 / $1,114.17 / $1,175.38	Facility	53	$475.66	$1,114.17	$1,175.38
Lucent Health Facility/Professional Facility Modifier AS Low / Median / High Price $237.83 / $557.08 / $587.69	Facility	AS	$237.83	$557.08	$587.69
Providence Facility/Professional Facility Modifier Low / Median / High Price $1,150.86 / $1,484.69 / $2,198.40	Facility		$1,150.86	$1,484.69	$2,198.40
Providence Facility/Professional Facility Modifier 52 Low / Median / High Price $1,091.32 / $1,091.32 / $1,091.32	Facility	52	$1,091.32	$1,091.32	$1,091.32
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $272.83 / $272.83 / $272.83	Facility	53	$272.83	$272.83	$272.83
Providence Facility/Professional Facility Modifier 80 Low / Median / High Price $467.15 / $467.15 / $467.15	Facility	80	$467.15	$467.15	$467.15
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $136.41 / $136.41 / $397.08	Facility	AS	$136.41	$136.41	$397.08
United Facility/Professional Facility Modifier Low / Median / High Price $1,204.00 / $4,675.00 / $20,279.00	Facility		$1,204.00	$4,675.00	$20,279.00