Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,654.92 / $9,674.00 / $22,788.00	Facility		$1,654.92	$9,674.00	$22,788.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $705.60 / $827.46 / $4,678.39	Facility	52	$705.60	$827.46	$4,678.39
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 $1,468.02 / $1,468.02 / $1,468.02	Facility	52	$1,468.02	$1,468.02	$1,468.02
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $183.50 / $183.50 / $183.50	Facility	AS	$183.50	$183.50	$183.50
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $1,011.91 / $1,531.32 / $2,304.13	Professional		$1,011.91	$1,531.32	$2,304.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,502.62 / $1,962.56 / $3,701.00	Professional		$1,502.62	$1,962.56	$3,701.00
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $222.78 / $280.95 / $500.00	Professional	80	$222.78	$280.95	$500.00
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $222.78 / $222.78 / $280.95	Professional	AS	$222.78	$222.78	$280.95
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $55.00 / $14,827.68 / $15,192.88	Facility		$55.00	$14,827.68	$15,192.88
Lucent Health Facility/Professional Facility Modifier 52 Low / Median / High Price $2,556.34 / $5,982.62 / $6,344.41	Facility	52	$2,556.34	$5,982.62	$6,344.41
Lucent Health Facility/Professional Facility Modifier AS Low / Median / High Price $319.54 / $747.83 / $793.05	Facility	AS	$319.54	$747.83	$793.05
Providence Facility/Professional Facility Modifier Low / Median / High Price $1,570.05 / $2,003.50 / $2,835.86	Facility		$1,570.05	$2,003.50	$2,835.86
Providence Facility/Professional Facility Modifier 52 Low / Median / High Price $1,468.02 / $1,468.02 / $1,468.02	Facility	52	$1,468.02	$1,468.02	$1,468.02
Providence Facility/Professional Facility Modifier 80 Low / Median / High Price $628.14 / $628.14 / $628.14	Facility	80	$628.14	$628.14	$628.14
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $183.50 / $183.50 / $533.91	Facility	AS	$183.50	$183.50	$533.91
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