Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,086.70 / $7,824.77 / $18,681.00	Facility		$3,086.70	$7,824.77	$18,681.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $684.45 / $734.35 / $3,426.08	Facility	54	$684.45	$734.35	$3,426.08
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $136.88 / $146.87 / $685.22	Facility	55	$136.88	$146.87	$685.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $750.39 / $920.63 / $3,484.15	Professional		$750.39	$920.63	$3,484.15
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $567.92 / $706.53 / $2,967.35	Professional	54	$567.92	$706.53	$2,967.35
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $113.59 / $136.88 / $593.47	Professional	55	$113.59	$136.88	$593.47
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $599.73 / $673.49 / $1,437.32	Professional		$599.73	$673.49	$1,437.32
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,456.00 / $10,275.00 / $21,136.00	Facility		$2,456.00	$10,275.00	$21,136.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,018.40 / $1,312.06 / $2,645.40	Professional		$1,018.40	$1,312.06	$2,645.40
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $66.70 / $100.00 / $14,458.60	Facility		$66.70	$100.00	$14,458.60
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $721.84 / $1,045.74 / $2,370.02	Professional		$721.84	$1,045.74	$2,370.02
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,071.60 / $1,726.46 / $2,353.27	Facility		$1,071.60	$1,726.46	$2,353.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $752.87 / $1,110.23 / $2,137.82	Professional		$752.87	$1,110.23	$2,137.82
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $879.29 / $1,055.15 / $1,702.52	Professional		$879.29	$1,055.15	$1,702.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $693.29 / $921.76 / $1,737.74	Professional		$693.29	$921.76	$1,737.74
Kaiser Permanente Facility/Professional Professional Modifier 50 Low / Median / High Price $2,970.00 / $2,970.00 / $2,970.00	Professional	50	$2,970.00	$2,970.00	$2,970.00
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $3,368.65 / $11,500.00 / $26,542.00	Facility		$3,368.65	$11,500.00	$26,542.00
Lucent Health Facility/Professional Facility Modifier 54 Low / Median / High Price $1,198.40 / $4,569.92 / $4,569.92	Facility	54	$1,198.40	$4,569.92	$4,569.92
Lucent Health Facility/Professional Facility Modifier 55 Low / Median / High Price $256.80 / $979.27 / $979.27	Facility	55	$256.80	$979.27	$979.27
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,925.00 / $6,925.00 / $6,925.00	Professional		$6,925.00	$6,925.00	$6,925.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $879.29 / $1,177.57 / $1,821.21	Facility		$879.29	$1,177.57	$1,821.21
Providence Facility/Professional Facility Modifier 54 Low / Median / High Price $1,385.02 / $1,385.02 / $1,385.02	Facility	54	$1,385.02	$1,385.02	$1,385.02
Providence Facility/Professional Facility Modifier 55 Low / Median / High Price $346.25 / $346.25 / $346.25	Facility	55	$346.25	$346.25	$346.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $774.03 / $1,131.85 / $2,143.21	Professional		$774.03	$1,131.85	$2,143.21
Providence Facility/Professional Professional Modifier 54 Low / Median / High Price $1,095.25 / $1,424.23 / $1,638.56	Professional	54	$1,095.25	$1,424.23	$1,638.56
Providence Facility/Professional Professional Modifier 55 Low / Median / High Price $273.81 / $356.06 / $409.64	Professional	55	$273.81	$356.06	$409.64
Sutter Health Plus Facility/Professional Facility Modifier Low / Median / High Price $4,027.00 / $4,027.00 / $4,027.00	Facility		$4,027.00	$4,027.00	$4,027.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $2,454.91 / $2,454.91 / $2,454.91	Professional		$2,454.91	$2,454.91	$2,454.91
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $773.87 / $1,311.61 / $2,162.98	Professional		$773.87	$1,311.61	$2,162.98
United Facility/Professional Facility Modifier Low / Median / High Price $3,523.00 / $7,384.00 / $15,471.00	Facility		$3,523.00	$7,384.00	$15,471.00
United Facility/Professional Professional Modifier Low / Median / High Price $608.04 / $848.00 / $1,782.87	Professional		$608.04	$848.00	$1,782.87