Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,536.78 / $9,919.00 / $22,788.00	Facility		$1,536.78	$9,919.00	$22,788.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $654.77 / $768.39 / $4,353.29	Facility	52	$654.77	$768.39	$4,353.29
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,022.00 / $10,869.95 / $24,548.00	Facility		$3,022.00	$10,869.95	$24,548.00
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 / $1,742.51 / $13,577.00	Facility		$633.00	$1,742.51	$13,577.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $1,366.02 / $1,366.02 / $1,366.02	Facility	52	$1,366.02	$1,366.02	$1,366.02
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $170.75 / $170.75 / $170.75	Facility	AS	$170.75	$170.75	$170.75
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $1,158.23 / $1,650.51 / $2,145.66	Professional		$1,158.23	$1,650.51	$2,145.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,399.13 / $1,826.74 / $3,420.10	Professional		$1,399.13	$1,826.74	$3,420.10
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $239.99 / $239.99 / $500.00	Professional	80	$239.99	$239.99	$500.00
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $239.99 / $239.99 / $239.99	Professional	AS	$239.99	$239.99	$239.99
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $2,800.00 / $11,355.04 / $14,134.40	Facility		$2,800.00	$11,355.04	$14,134.40
Lucent Health Facility/Professional Facility Modifier 52 Low / Median / High Price $2,379.78 / $5,570.85 / $5,907.44	Facility	52	$2,379.78	$5,570.85	$5,907.44
Lucent Health Facility/Professional Facility Modifier AS Low / Median / High Price $297.47 / $696.36 / $738.43	Facility	AS	$297.47	$696.36	$738.43
Providence Facility/Professional Facility Modifier Low / Median / High Price $1,461.39 / $1,860.45 / $2,648.13	Facility		$1,461.39	$1,860.45	$2,648.13
Providence Facility/Professional Facility Modifier 52 Low / Median / High Price $1,366.02 / $1,366.02 / $1,366.02	Facility	52	$1,366.02	$1,366.02	$1,366.02
Providence Facility/Professional Facility Modifier 80 Low / Median / High Price $585.23 / $585.23 / $585.23	Facility	80	$585.23	$585.23	$585.23
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $170.75 / $170.75 / $497.44	Facility	AS	$170.75	$170.75	$497.44
United Facility/Professional Facility Modifier Low / Median / High Price $3,483.00 / $12,186.00 / $26,672.00	Facility		$3,483.00	$12,186.00	$26,672.00