Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,735.00 / $8,415.00 / $9,900.00	Facility		$3,735.00	$8,415.00	$9,900.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $3,105.00 / $3,735.00 / $3,825.00	Professional		$3,105.00	$3,735.00	$3,825.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,978.38 / $6,622.95 / $14,692.14	Facility		$3,978.38	$6,622.95	$14,692.14
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,624.62 / $3,825.00 / $7,344.00	Professional		$1,624.62	$3,825.00	$7,344.00
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $98.20 / $1,567.57 / $5,360.25	Facility		$98.20	$1,567.57	$5,360.25
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $674.39 / $963.42 / $2,348.53	Professional		$674.39	$963.42	$2,348.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,825.00 / $3,825.00 / $3,825.00	Facility		$3,825.00	$3,825.00	$3,825.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $3,825.00 / $3,825.00 / $3,825.00	Professional		$3,825.00	$3,825.00	$3,825.00
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $706.23 / $706.23 / $847.48	Professional		$706.23	$706.23	$847.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $393.93 / $393.93 / $393.93	Professional		$393.93	$393.93	$393.93
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $4,275.00 / $20,731.70 / $20,731.70	Facility		$4,275.00	$20,731.70	$20,731.70
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $17,100.00 / $17,100.00 / $20,250.00	Professional		$17,100.00	$17,100.00	$20,250.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $49.20 / $49.20 / $85.00	Professional		$49.20	$49.20	$85.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $647.01 / $3,825.00 / $5,341.05	Facility		$647.01	$3,825.00	$5,341.05
Providence Facility/Professional Professional Modifier Low / Median / High Price $3,825.00 / $3,825.00 / $4,500.00	Professional		$3,825.00	$3,825.00	$4,500.00
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $706.23 / $776.85 / $1,200.58	Professional		$706.23	$776.85	$1,200.58
United Facility/Professional Professional Modifier Low / Median / High Price $3,750.00 / $3,750.00 / $6,891.00	Professional		$3,750.00	$3,750.00	$6,891.00