Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $3,981.07 / $12,022.64	Facility		$630.96	$3,981.07	$12,022.64
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $2,137.96 / $5,623.41 / $7,079.46	Facility	52	$2,137.96	$5,623.41	$7,079.46
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $63.10 / $128.82 / $302.00	Facility	53	$63.10	$128.82	$302.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $363.08 / $1,096.48	Professional		$181.97	$363.08	$1,096.48
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $58.88 / $138.04 / $371.54	Professional	53	$58.88	$138.04	$371.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $190.55 / $338.84	Professional		$147.91	$190.55	$338.84
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $43.65 / $83.18 / $125.89	Professional	53	$43.65	$83.18	$125.89
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,570.40 / $4,466.84 / $12,022.64	Facility		$2,570.40	$4,466.84	$12,022.64
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $407.38 / $676.08	Professional		$263.03	$407.38	$676.08
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $91.20 / $125.89 / $229.09	Professional	53	$91.20	$125.89	$229.09
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $1,659.59 / $7,413.10	Facility		$66.07	$1,659.59	$7,413.10
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $426.58 / $831.76	Professional		$234.42	$426.58	$831.76
Blue Shield Facility/Professional Professional Modifier 53 Low / Median / High Price $100.00 / $478.63 / $1,071.52	Professional	53	$100.00	$478.63	$1,071.52
Cigna Facility/Professional Facility Modifier Low / Median / High Price $537.03 / $724.44 / $1,258.93	Facility		$537.03	$724.44	$1,258.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $371.54 / $660.69	Professional		$213.80	$371.54	$660.69
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $79.43 / $120.23 / $229.09	Professional	53	$79.43	$120.23	$229.09
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $295.12 / $630.96	Professional		$186.21	$295.12	$630.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $363.08 / $707.95	Professional		$165.96	$363.08	$707.95
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $83.18 / $186.21 / $363.08	Professional	53	$83.18	$186.21	$363.08
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $2,754.23 / $2,754.23 / $28,840.32	Facility		$2,754.23	$2,754.23	$28,840.32
Lucent Health Facility/Professional Facility Modifier 52 Low / Median / High Price $2,238.72 / $2,238.72 / $2,238.72	Facility	52	$2,238.72	$2,238.72	$2,238.72
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $549.54 / $549.54 / $549.54	Facility	53	$549.54	$549.54	$549.54
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $2,818.38 / $2,884.03	Professional		$281.84	$2,818.38	$2,884.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $281.84 / $478.63	Professional		$281.84	$281.84	$478.63
Providence Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $380.19 / $676.08	Facility		$199.53	$380.19	$676.08
Providence Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $380.19 / $741.31	Professional		$213.80	$380.19	$741.31
Providence Facility/Professional Professional Modifier 53 Low / Median / High Price $79.43 / $120.23 / $218.78	Professional	53	$79.43	$120.23	$218.78
Sutter Health Plus Facility/Professional Facility Modifier Low / Median / High Price $1,819.70 / $1,819.70 / $1,819.70	Facility		$1,819.70	$1,819.70	$1,819.70
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $602.56 / $1,096.48	Professional		$602.56	$602.56	$1,096.48
Sutter Health Plus Facility/Professional Professional Modifier 53 Low / Median / High Price $302.00 / $302.00 / $549.54	Professional	53	$302.00	$302.00	$549.54
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $416.87 / $562.34	Professional		$169.82	$416.87	$562.34
United Facility/Professional Facility Modifier Low / Median / High Price $1,778.28 / $3,981.07 / $9,120.11	Facility		$1,778.28	$3,981.07	$9,120.11
United Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $302.00 / $575.44	Professional		$169.82	$302.00	$575.44
United Facility/Professional Professional Modifier 53 Low / Median / High Price $70.79 / $151.36 / $218.78	Professional	53	$70.79	$151.36	$218.78