Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $411.00 / $4,749.00 / $17,054.00	Facility		$411.00	$4,749.00	$17,054.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $31.07 / $82.31 / $455.27	Facility	53	$31.07	$82.31	$455.27
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $873.00 / $4,314.00 / $8,260.00	Facility		$873.00	$4,314.00	$8,260.00
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $67.90 / $100.00 / $4,886.39	Facility		$67.90	$100.00	$4,886.39
Cigna Facility/Professional Facility Modifier Low / Median / High Price $339.00 / $730.77 / $1,721.63	Facility		$339.00	$730.77	$1,721.63
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $52.70 / $52.70 / $52.70	Facility	53	$52.70	$52.70	$52.70
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $160.09 / $205.30 / $527.77	Professional		$160.09	$205.30	$527.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $154.72 / $321.20 / $567.12	Professional		$154.72	$321.20	$567.12
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $85.54 / $174.52 / $300.14	Professional	53	$85.54	$174.52	$300.14
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $878.90 / $899.00 / $12,000.00	Facility		$878.90	$899.00	$12,000.00
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $140.78 / $151.40 / $151.40	Facility	53	$140.78	$151.40	$151.40
Providence Facility/Professional Facility Modifier Low / Median / High Price $172.58 / $320.97 / $540.15	Facility		$172.58	$320.97	$540.15
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $52.70 / $52.70 / $52.70	Facility	53	$52.70	$52.70	$52.70
United Facility/Professional Facility Modifier Low / Median / High Price $833.75 / $3,964.00 / $9,131.00	Facility		$833.75	$3,964.00	$9,131.00