Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $279.55 / $4,848.00 / $16,125.00	Facility		$279.55	$4,848.00	$16,125.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $15.98 / $42.20 / $256.76	Facility	53	$15.98	$42.20	$256.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $76.23 / $188.23 / $586.52	Professional		$76.23	$188.23	$586.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.63 / $133.29 / $399.85	Professional		$77.63	$133.29	$399.85
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,143.00 / $5,931.00 / $11,994.00	Facility		$2,143.00	$5,931.00	$11,994.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.90 / $163.79 / $302.60	Professional		$107.90	$163.79	$302.60
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $77.09 / $100.00 / $27,955.87	Facility		$77.09	$100.00	$27,955.87
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $82.08 / $180.61 / $369.81	Professional		$82.08	$180.61	$369.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $140.54 / $140.54 / $140.54	Facility		$140.54	$140.54	$140.54
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $28.11 / $28.11 / $28.11	Facility	53	$28.11	$28.11	$28.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.66 / $199.77 / $395.61	Professional		$89.66	$199.77	$395.61
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $88.61 / $123.98 / $311.74	Professional		$88.61	$123.98	$311.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $82.35 / $175.95 / $309.43	Professional		$82.35	$175.95	$309.43
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $55.00 / $404.80 / $580.01	Facility		$55.00	$404.80	$580.01
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $63.80 / $80.95 / $80.95	Facility	53	$63.80	$80.95	$80.95
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,088.00 / $1,537.05 / $1,604.71	Professional		$1,088.00	$1,537.05	$1,604.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $155.35	Professional		$32.34	$32.34	$155.35
Providence Facility/Professional Facility Modifier Low / Median / High Price $87.84 / $182.00 / $345.46	Facility		$87.84	$182.00	$345.46
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $28.11 / $28.11 / $28.11	Facility	53	$28.11	$28.11	$28.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $217.27 / $470.13	Professional		$93.33	$217.27	$470.13
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $282.81 / $282.81 / $662.69	Professional		$282.81	$282.81	$662.69
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $83.44 / $145.26 / $256.69	Professional		$83.44	$145.26	$256.69
United Facility/Professional Facility Modifier Low / Median / High Price $421.00 / $1,495.00 / $5,830.00	Facility		$421.00	$1,495.00	$5,830.00
United Facility/Professional Professional Modifier Low / Median / High Price $164.14 / $243.38 / $553.60	Professional		$164.14	$243.38	$553.60