Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $643.89 / $4,848.00 / $15,877.00	Facility		$643.89	$4,848.00	$15,877.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $388.47 / $440.60 / $3,225.66	Facility	54	$388.47	$440.60	$3,225.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $487.02 / $646.21 / $2,074.16	Professional		$487.02	$646.21	$2,074.16
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $365.27 / $482.92 / $2,391.52	Professional	54	$365.27	$482.92	$2,391.52
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $73.05 / $96.58 / $478.30	Professional	55	$73.05	$96.58	$478.30
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $512.58 / $591.46 / $684.54	Professional		$512.58	$591.46	$684.54
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,546.00 / $4,617.00 / $9,381.00	Facility		$1,546.00	$4,617.00	$9,381.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $546.22 / $783.29 / $1,522.29	Professional		$546.22	$783.29	$1,522.29
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $845.56 / $1,005.34 / $1,236.77	Professional	50	$845.56	$1,005.34	$1,236.77
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $66.00 / $100.00 / $5,122.07	Facility		$66.00	$100.00	$5,122.07
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $421.81 / $602.59 / $1,392.47	Professional		$421.81	$602.59	$1,392.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $372.64 / $705.15 / $961.17	Facility		$372.64	$705.15	$961.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $548.73 / $759.88 / $1,615.20	Professional		$548.73	$759.88	$1,615.20
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $337.30 / $798.17 / $1,016.70	Professional		$337.30	$798.17	$1,016.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $582.64 / $809.23 / $1,450.79	Professional		$582.64	$809.23	$1,450.79
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $4,117.62 / $4,230.84 / $12,000.00	Facility		$4,117.62	$4,230.84	$12,000.00
Lucent Health Facility/Professional Facility Modifier 54 Low / Median / High Price $1,904.24 / $2,152.54 / $2,152.54	Facility	54	$1,904.24	$2,152.54	$2,152.54
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $4,370.96 / $5,003.20 / $5,720.33	Professional		$4,370.96	$5,003.20	$5,720.33
Providence Facility/Professional Facility Modifier Low / Median / High Price $605.80 / $786.43 / $1,092.00	Facility		$605.80	$786.43	$1,092.00
Providence Facility/Professional Facility Modifier 54 Low / Median / High Price $1,298.94 / $1,298.94 / $1,298.94	Facility	54	$1,298.94	$1,298.94	$1,298.94
Providence Facility/Professional Professional Modifier Low / Median / High Price $552.02 / $803.81 / $1,736.50	Professional		$552.02	$803.81	$1,736.50
Providence Facility/Professional Professional Modifier 54 Low / Median / High Price $1,027.18 / $1,279.52 / $1,536.72	Professional	54	$1,027.18	$1,279.52	$1,536.72
Providence Facility/Professional Professional Modifier 55 Low / Median / High Price $256.79 / $319.88 / $384.18	Professional	55	$256.79	$319.88	$384.18
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,978.52 / $1,978.52 / $2,264.63	Professional		$1,978.52	$1,978.52	$2,264.63
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $438.49 / $638.04 / $806.47	Professional		$438.49	$638.04	$806.47
United Facility/Professional Facility Modifier Low / Median / High Price $1,800.00 / $4,038.00 / $9,072.00	Facility		$1,800.00	$4,038.00	$9,072.00
United Facility/Professional Professional Modifier Low / Median / High Price $518.94 / $679.35 / $1,655.66	Professional		$518.94	$679.35	$1,655.66