Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $701.60 / $3,850.00 / $14,472.00	Facility		$701.60	$3,850.00	$14,472.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,398.00 / $2,097.00 / $7,653.00	Facility	50	$1,398.00	$2,097.00	$7,653.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $201.86 / $220.85 / $1,571.61	Facility	54	$201.86	$220.85	$1,571.61
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $40.36 / $44.17 / $314.32	Facility	55	$40.36	$44.17	$314.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.89 / $342.98 / $813.98	Professional		$257.89	$342.98	$813.98
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $436.08 / $562.74 / $2,346.00	Professional	50	$436.08	$562.74	$2,346.00
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $185.85 / $251.59 / $1,241.96	Professional	54	$185.85	$251.59	$1,241.96
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $37.17 / $48.11 / $248.39	Professional	55	$37.17	$48.11	$248.39
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $251.98 / $288.86 / $532.53	Professional		$251.98	$288.86	$532.53
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $414.68 / $414.68 / $527.76	Professional	50	$414.68	$414.68	$527.76
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,097.00 / $5,694.00 / $11,233.00	Facility		$2,097.00	$5,694.00	$11,233.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $280.27 / $422.90 / $823.01	Professional		$280.27	$422.90	$823.01
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $424.50 / $487.03 / $607.85	Professional	50	$424.50	$487.03	$607.85
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $66.70 / $100.00 / $6,564.23	Facility		$66.70	$100.00	$6,564.23
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $196.53 / $280.76 / $668.52	Professional		$196.53	$280.76	$668.52
Cigna Facility/Professional Facility Modifier Low / Median / High Price $418.74 / $558.13 / $745.00	Facility		$418.74	$558.13	$745.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $264.94 / $370.73 / $838.15	Professional		$264.94	$370.73	$838.15
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $186.15 / $409.45 / $512.49	Professional		$186.15	$409.45	$512.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $302.37 / $407.15 / $739.13	Professional		$302.37	$407.15	$739.13
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $1,765.45 / $1,826.65 / $16,394.00	Facility		$1,765.45	$1,826.65	$16,394.00
Lucent Health Facility/Professional Facility Modifier 54 Low / Median / High Price $979.13 / $1,117.09 / $1,117.09	Facility	54	$979.13	$1,117.09	$1,117.09
Lucent Health Facility/Professional Facility Modifier 55 Low / Median / High Price $209.81 / $239.38 / $239.38	Facility	55	$209.81	$239.38	$239.38
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,245.28 / $2,492.32 / $2,743.50	Professional		$2,245.28	$2,492.32	$2,743.50
Providence Facility/Professional Facility Modifier Low / Median / High Price $317.42 / $407.15 / $641.71	Facility		$317.42	$407.15	$641.71
Providence Facility/Professional Facility Modifier 54 Low / Median / High Price $626.34 / $626.34 / $626.34	Facility	54	$626.34	$626.34	$626.34
Providence Facility/Professional Facility Modifier 55 Low / Median / High Price $156.59 / $156.59 / $156.59	Facility	55	$156.59	$156.59	$156.59
Providence Facility/Professional Professional Modifier Low / Median / High Price $273.86 / $397.73 / $877.74	Professional		$273.86	$397.73	$877.74
Providence Facility/Professional Professional Modifier 54 Low / Median / High Price $495.30 / $616.98 / $741.00	Professional	54	$495.30	$616.98	$741.00
Providence Facility/Professional Professional Modifier 55 Low / Median / High Price $123.83 / $154.24 / $185.25	Professional	55	$123.83	$154.24	$185.25
Sutter Health Plus Facility/Professional Facility Modifier Low / Median / High Price $977.00 / $977.00 / $977.00	Facility		$977.00	$977.00	$977.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,027.49 / $1,027.49 / $1,098.42	Professional		$1,027.49	$1,027.49	$1,098.42
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $242.00 / $335.07 / $422.55	Professional		$242.00	$335.07	$422.55
United Facility/Professional Facility Modifier Low / Median / High Price $894.00 / $2,637.00 / $7,399.00	Facility		$894.00	$2,637.00	$7,399.00
United Facility/Professional Professional Modifier Low / Median / High Price $251.36 / $329.00 / $827.20	Professional		$251.36	$329.00	$827.20