Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $4,182.00 / $11,299.00 / $24,202.80	Facility		$4,182.00	$11,299.00	$24,202.80
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $3,464.00 / $3,464.00 / $123,249.18	Facility	22	$3,464.00	$3,464.00	$123,249.18
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $316.35 / $375.75 / $1,879.90	Facility	52	$316.35	$375.75	$1,879.90
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $126.54 / $150.30 / $751.96	Facility	53	$126.54	$150.30	$751.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $632.69 / $1,000.06 / $3,074.00	Professional		$632.69	$1,000.06	$3,074.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $532.34 / $632.16 / $748.62	Professional		$532.34	$632.16	$748.62
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,143.00 / $13,707.00 / $30,857.00	Facility		$2,143.00	$13,707.00	$30,857.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $828.88 / $1,086.39 / $2,088.78	Professional		$828.88	$1,086.39	$2,088.78
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $69.80 / $100.00 / $14,792.21	Facility		$69.80	$100.00	$14,792.21
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $511.46 / $757.96 / $1,727.61	Professional		$511.46	$757.96	$1,727.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $753.07 / $4,500.00 / $13,439.00	Facility		$753.07	$4,500.00	$13,439.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $594.13 / $594.13 / $594.13	Facility	52	$594.13	$594.13	$594.13
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $148.53 / $148.53 / $148.53	Facility	53	$148.53	$148.53	$148.53
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $74.27 / $74.27 / $74.27	Facility	AS	$74.27	$74.27	$74.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $641.19 / $850.59 / $1,860.12	Professional		$641.19	$850.59	$1,860.12
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $466.12 / $726.10 / $980.24	Professional		$466.12	$726.10	$980.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $637.29 / $802.48 / $1,497.23	Professional		$637.29	$802.48	$1,497.23
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $102.39 / $129.12 / $500.00	Professional	80	$102.39	$129.12	$500.00
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $102.39 / $102.39 / $129.12	Professional	AS	$102.39	$102.39	$129.12
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $4,956.00 / $10,160.00 / $16,223.75	Facility		$4,956.00	$10,160.00	$16,223.75
Lucent Health Facility/Professional Facility Modifier 52 Low / Median / High Price $1,169.61 / $12,302.24 / $12,302.24	Facility	52	$1,169.61	$12,302.24	$12,302.24
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $292.39 / $3,075.56 / $3,075.56	Facility	53	$292.39	$3,075.56	$3,075.56
Lucent Health Facility/Professional Facility Modifier AS Low / Median / High Price $146.19 / $1,537.78 / $1,537.78	Facility	AS	$146.19	$1,537.78	$1,537.78
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $4,971.47 / $4,971.47 / $5,729.25	Professional		$4,971.47	$4,971.47	$5,729.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $969.93	Professional		$32.34	$32.34	$969.93
Providence Facility/Professional Facility Modifier Low / Median / High Price $663.60 / $865.06 / $1,539.48	Facility		$663.60	$865.06	$1,539.48
Providence Facility/Professional Facility Modifier 52 Low / Median / High Price $594.13 / $594.13 / $594.13	Facility	52	$594.13	$594.13	$594.13
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $148.53 / $148.53 / $148.53	Facility	53	$148.53	$148.53	$148.53
Providence Facility/Professional Facility Modifier 80 Low / Median / High Price $253.88 / $253.88 / $253.88	Facility	80	$253.88	$253.88	$253.88
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $74.27 / $74.27 / $215.80	Facility	AS	$74.27	$74.27	$215.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $641.19 / $897.67 / $1,775.44	Professional		$641.19	$897.67	$1,775.44
Sutter Health Plus Facility/Professional Facility Modifier Low / Median / High Price $8,321.00 / $8,321.00 / $8,321.00	Facility		$8,321.00	$8,321.00	$8,321.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $2,115.54 / $2,115.54 / $2,115.54	Professional		$2,115.54	$2,115.54	$2,115.54
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $466.12 / $660.64 / $839.02	Professional		$466.12	$660.64	$839.02
United Facility/Professional Facility Modifier Low / Median / High Price $4,578.00 / $13,171.00 / $29,312.00	Facility		$4,578.00	$13,171.00	$29,312.00
United Facility/Professional Professional Modifier Low / Median / High Price $537.32 / $746.45 / $1,591.49	Professional		$537.32	$746.45	$1,591.49