Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,822.00 / $10,976.00 / $22,788.00	Facility		$3,822.00	$10,976.00	$22,788.00
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $2.52 / $2.52 / $2.52	Facility	22	$2.52	$2.52	$2.52
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $319.98 / $378.90 / $2,043.00	Facility	52	$319.98	$378.90	$2,043.00
Aetna Facility/Professional Facility Modifier 80 Low / Median / High Price $3,729.80 / $3,729.80 / $7,069.36	Facility	80	$3,729.80	$3,729.80	$7,069.36
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,988.00 / $13,707.00 / $30,857.00	Facility		$1,988.00	$13,707.00	$30,857.00
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
Cigna Facility/Professional Facility Modifier Low / Median / High Price $766.00 / $4,598.91 / $13,439.00	Facility		$766.00	$4,598.91	$13,439.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $645.72 / $645.72 / $645.72	Facility	52	$645.72	$645.72	$645.72
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $80.72 / $80.72 / $80.72	Facility	AS	$80.72	$80.72	$80.72
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $536.48 / $787.22 / $1,062.75	Professional		$536.48	$787.22	$1,062.75
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $690.81 / $871.92 / $1,619.00	Professional		$690.81	$871.92	$1,619.00
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $117.94 / $148.74 / $500.00	Professional	80	$117.94	$148.74	$500.00
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $117.94 / $117.94 / $148.74	Professional	AS	$117.94	$117.94	$148.74
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $5,389.76 / $10,160.00 / $16,223.75	Facility		$5,389.76	$10,160.00	$16,223.75
Lucent Health Facility/Professional Facility Modifier 52 Low / Median / High Price $1,270.22 / $12,302.24 / $12,302.24	Facility	52	$1,270.22	$12,302.24	$12,302.24
Lucent Health Facility/Professional Facility Modifier AS Low / Median / High Price $158.78 / $1,537.78 / $1,537.78	Facility	AS	$158.78	$1,537.78	$1,537.78
Providence Facility/Professional Facility Modifier Low / Median / High Price $701.35 / $925.91 / $1,641.15	Facility		$701.35	$925.91	$1,641.15
Providence Facility/Professional Facility Modifier 52 Low / Median / High Price $645.72 / $645.72 / $645.72	Facility	52	$645.72	$645.72	$645.72
Providence Facility/Professional Facility Modifier 80 Low / Median / High Price $276.23 / $276.23 / $276.23	Facility	80	$276.23	$276.23	$276.23
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $80.72 / $80.72 / $234.80	Facility	AS	$80.72	$80.72	$234.80
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
United Facility/Professional Facility Modifier Low / Median / High Price $4,578.00 / $13,078.00 / $29,312.00	Facility		$4,578.00	$13,078.00	$29,312.00