Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,497.75 / $9,677.00 / $23,246.00	Facility		$3,497.75	$9,677.00	$23,246.00
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $4,406.00 / $4,406.00 / $4,406.00	Facility	22	$4,406.00	$4,406.00	$4,406.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $5,324.32 / $16,162.00 / $33,511.44	Facility	50	$5,324.32	$16,162.00	$33,511.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $349.55 / $560.99 / $1,824.00	Professional		$349.55	$560.99	$1,824.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $362.71 / $408.05 / $948.04	Professional		$362.71	$408.05	$948.04
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,800.00 / $8,484.00 / $18,150.00	Facility		$1,800.00	$8,484.00	$18,150.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $471.88 / $641.39 / $1,214.53	Professional		$471.88	$641.39	$1,214.53
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $69.80 / $100.00 / $10,628.65	Facility		$69.80	$100.00	$10,628.65
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $303.55 / $450.84 / $1,063.94	Professional		$303.55	$450.84	$1,063.94
Cigna Facility/Professional Facility Modifier Low / Median / High Price $633.00 / $4,270.41 / $13,360.00	Facility		$633.00	$4,270.41	$13,360.00
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $48.91 / $48.91 / $48.91	Facility	AS	$48.91	$48.91	$48.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $398.35 / $538.02 / $1,218.48	Professional		$398.35	$538.02	$1,218.48
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $264.70 / $488.61 / $659.62	Professional		$264.70	$488.61	$659.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $408.05 / $535.46 / $997.46	Professional		$408.05	$535.46	$997.46
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $58.16 / $58.16 / $500.00	Professional	80	$58.16	$58.16	$500.00
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $58.16 / $58.16 / $58.16	Professional	AS	$58.16	$58.16	$58.16
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $2,853.69 / $16,223.75 / $26,542.00	Facility		$2,853.69	$16,223.75	$26,542.00
Lucent Health Facility/Professional Facility Modifier AS Low / Median / High Price $96.86 / $1,537.78 / $1,537.78	Facility	AS	$96.86	$1,537.78	$1,537.78
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,959.35 / $3,959.35 / $3,959.35	Professional		$3,959.35	$3,959.35	$3,959.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $634.74	Professional		$32.34	$32.34	$634.74
Providence Facility/Professional Facility Modifier Low / Median / High Price $423.72 / $550.84 / $885.23	Facility		$423.72	$550.84	$885.23
Providence Facility/Professional Facility Modifier 80 Low / Median / High Price $166.38 / $166.38 / $166.38	Facility	80	$166.38	$166.38	$166.38
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $48.91 / $48.91 / $141.43	Facility	AS	$48.91	$48.91	$141.43
Providence Facility/Professional Professional Modifier Low / Median / High Price $398.53 / $574.65 / $1,162.96	Professional		$398.53	$574.65	$1,162.96
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 $1,386.91 / $1,386.91 / $1,386.91	Professional		$1,386.91	$1,386.91	$1,386.91
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $264.70 / $443.27 / $541.77	Professional		$264.70	$443.27	$541.77
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 $346.76 / $462.56 / $1,232.98	Professional		$346.76	$462.56	$1,232.98