Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $629.58 / $3,681.62 / $12,448.00	Facility		$629.58	$3,681.62	$12,448.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $101.81 / $193.60 / $1,041.17	Facility	52	$101.81	$193.60	$1,041.17
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $46.02 / $91.80 / $416.47	Facility	53	$46.02	$91.80	$416.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $186.69 / $347.01 / $973.49	Professional		$186.69	$347.01	$973.49
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $54.03 / $111.64 / $321.05	Professional	53	$54.03	$111.64	$321.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $160.32 / $188.61 / $410.90	Professional		$160.32	$188.61	$410.90
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $78.47 / $89.88 / $136.30	Professional	53	$78.47	$89.88	$136.30
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,000.00 / $4,314.00 / $8,260.00	Facility		$1,000.00	$4,314.00	$8,260.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $248.59 / $374.49 / $747.25	Professional		$248.59	$374.49	$747.25
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $94.64 / $126.25 / $226.48	Professional	53	$94.64	$126.25	$226.48
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $69.80 / $100.00 / $6,501.89	Facility		$69.80	$100.00	$6,501.89
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $223.79 / $412.10 / $780.16	Professional		$223.79	$412.10	$780.16
Blue Shield Facility/Professional Professional Modifier 53 Low / Median / High Price $100.00 / $306.89 / $590.49	Professional	53	$100.00	$306.89	$590.49
Cigna Facility/Professional Facility Modifier Low / Median / High Price $455.00 / $730.77 / $1,881.00	Facility		$455.00	$730.77	$1,881.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $248.66 / $248.66 / $248.66	Facility	52	$248.66	$248.66	$248.66
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $62.17 / $62.17 / $62.17	Facility	53	$62.17	$62.17	$62.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.16 / $382.55 / $734.34	Professional		$213.16	$382.55	$734.34
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $79.29 / $116.81 / $220.49	Professional	53	$79.29	$116.81	$220.49
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $203.08 / $310.06 / $562.29	Professional		$203.08	$310.06	$562.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $182.62 / $344.13 / $625.29	Professional		$182.62	$344.13	$625.29
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $101.54 / $187.43 / $322.80	Professional	53	$101.54	$187.43	$322.80
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $1,038.84 / $1,063.59 / $16,394.00	Facility		$1,038.84	$1,063.59	$16,394.00
Lucent Health Facility/Professional Facility Modifier 52 Low / Median / High Price $663.66 / $716.72 / $716.72	Facility	52	$663.66	$716.72	$716.72
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $165.92 / $179.18 / $179.18	Facility	53	$165.92	$179.18	$179.18
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,345.00 / $2,761.67 / $2,852.81	Professional		$1,345.00	$2,761.67	$2,852.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $349.24	Professional		$32.34	$32.34	$349.24
Providence Facility/Professional Facility Modifier Low / Median / High Price $208.54 / $359.27 / $607.53	Facility		$208.54	$359.27	$607.53
Providence Facility/Professional Facility Modifier 52 Low / Median / High Price $248.66 / $248.66 / $248.66	Facility	52	$248.66	$248.66	$248.66
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $62.17 / $62.17 / $62.17	Facility	53	$62.17	$62.17	$62.17
Providence Facility/Professional Professional Modifier Low / Median / High Price $219.64 / $415.87 / $832.20	Professional		$219.64	$415.87	$832.20
Providence Facility/Professional Professional Modifier 53 Low / Median / High Price $79.29 / $120.76 / $267.63	Professional	53	$79.29	$120.76	$267.63
Sutter Health Plus Facility/Professional Facility Modifier Low / Median / High Price $1,838.00 / $1,838.00 / $1,838.00	Facility		$1,838.00	$1,838.00	$1,838.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $604.02 / $604.02 / $1,093.29	Professional		$604.02	$604.02	$1,093.29
Sutter Health Plus Facility/Professional Professional Modifier 53 Low / Median / High Price $302.33 / $302.33 / $547.57	Professional	53	$302.33	$302.33	$547.57
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $184.43 / $372.31 / $521.24	Professional		$184.43	$372.31	$521.24
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
United Facility/Professional Professional Modifier Low / Median / High Price $271.97 / $401.10 / $827.76	Professional		$271.97	$401.10	$827.76
United Facility/Professional Professional Modifier 53 Low / Median / High Price $151.09 / $165.30 / $220.49	Professional	53	$151.09	$165.30	$220.49