Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $411.00 / $4,471.60 / $15,572.00	Facility		$411.00	$4,471.60	$15,572.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,247.75 / $4,269.00 / $5,389.50	Facility	50	$1,247.75	$4,269.00	$5,389.50
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $182.85 / $217.60 / $1,423.45	Facility	54	$182.85	$217.60	$1,423.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $240.37 / $294.86 / $1,192.39	Professional		$240.37	$294.86	$1,192.39
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $341.79 / $481.37 / $2,704.50	Professional	50	$341.79	$481.37	$2,704.50
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $167.55 / $217.60 / $1,089.47	Professional	54	$167.55	$217.60	$1,089.47
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $33.51 / $43.52 / $217.89	Professional	55	$33.51	$43.52	$217.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $202.27 / $257.41 / $507.18	Professional		$202.27	$257.41	$507.18
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $399.56 / $399.56 / $399.56	Professional	50	$399.56	$399.56	$399.56
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,546.00 / $4,465.00 / $8,976.00	Facility		$1,546.00	$4,465.00	$8,976.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $353.51 / $521.89 / $914.32	Professional		$353.51	$521.89	$914.32
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $384.22 / $460.50 / $645.00	Professional	50	$384.22	$460.50	$645.00
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $66.00 / $100.00 / $5,021.77	Facility		$66.00	$100.00	$5,021.77
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $283.04 / $404.34 / $885.73	Professional		$283.04	$404.34	$885.73
Cigna Facility/Professional Facility Modifier Low / Median / High Price $256.61 / $349.78 / $555.00	Facility		$256.61	$349.78	$555.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.50 / $386.62 / $714.36	Professional		$251.50	$386.62	$714.36
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $210.72 / $318.89 / $438.01	Professional		$210.72	$318.89	$438.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $235.50 / $326.91 / $584.69	Professional		$235.50	$326.91	$584.69
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $55.00 / $1,869.28 / $1,933.96	Facility		$55.00	$1,869.28	$1,933.96
Lucent Health Facility/Professional Facility Modifier 54 Low / Median / High Price $740.71 / $836.14 / $836.14	Facility	54	$740.71	$836.14	$836.14
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,831.00 / $2,831.00 / $2,831.00	Professional		$2,831.00	$2,831.00	$2,831.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $285.56 / $409.68 / $672.00	Facility		$285.56	$409.68	$672.00
Providence Facility/Professional Facility Modifier 54 Low / Median / High Price $563.38 / $563.38 / $563.38	Facility	54	$563.38	$563.38	$563.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $260.22 / $415.90 / $759.88	Professional		$260.22	$415.90	$759.88
Providence Facility/Professional Professional Modifier 54 Low / Median / High Price $445.52 / $554.97 / $666.52	Professional	54	$445.52	$554.97	$666.52
Providence Facility/Professional Professional Modifier 55 Low / Median / High Price $111.38 / $138.74 / $166.63	Professional	55	$111.38	$138.74	$166.63
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $775.20 / $775.20 / $992.79	Professional		$775.20	$775.20	$992.79
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $246.29 / $314.88 / $405.77	Professional		$246.29	$314.88	$405.77
United Facility/Professional Facility Modifier Low / Median / High Price $1,031.00 / $2,699.00 / $7,655.00	Facility		$1,031.00	$2,699.00	$7,655.00
United Facility/Professional Professional Modifier Low / Median / High Price $240.46 / $344.66 / $749.48	Professional		$240.46	$344.66	$749.48