Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $439.03 / $4,950.00 / $16,713.00	Facility		$439.03	$4,950.00	$16,713.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $94.71 / $180.09 / $880.49	Facility	52	$94.71	$180.09	$880.49
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $37.88 / $87.81 / $486.20	Facility	53	$37.88	$87.81	$486.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.09 / $294.62 / $927.53	Professional		$180.09	$294.62	$927.53
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $43.23 / $97.77 / $275.98	Professional	53	$43.23	$97.77	$275.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $160.32 / $198.04 / $413.06	Professional		$160.32	$198.04	$413.06
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,196.00 / $5,357.00 / $10,576.00	Facility		$1,196.00	$5,357.00	$10,576.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.95 / $383.22 / $928.47	Professional		$204.95	$383.22	$928.47
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $94.64 / $178.95 / $265.70	Professional	53	$94.64	$178.95	$265.70
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $74.50 / $100.00 / $2,073.62	Facility		$74.50	$100.00	$2,073.62
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $211.68 / $394.74 / $752.49	Professional		$211.68	$394.74	$752.49
Blue Shield Facility/Professional Professional Modifier 53 Low / Median / High Price $100.00 / $306.55 / $590.08	Professional	53	$100.00	$306.55	$590.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $562.13 / $766.00 / $1,881.00	Facility		$562.13	$766.00	$1,881.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $194.61 / $194.61 / $194.61	Facility	52	$194.61	$194.61	$194.61
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $48.65 / $48.65 / $48.65	Facility	53	$48.65	$48.65	$48.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.45 / $301.45 / $324.18	Professional		$301.45	$301.45	$324.18
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $106.08 / $121.92 / $188.42	Professional	53	$106.08	$121.92	$188.42
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $203.08 / $416.51 / $562.29	Professional		$203.08	$416.51	$562.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $182.62 / $346.50 / $624.77	Professional		$182.62	$346.50	$624.77
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $101.54 / $187.43 / $319.77	Professional	53	$101.54	$187.43	$319.77
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $1,038.84 / $1,063.59 / $16,394.00	Facility		$1,038.84	$1,063.59	$16,394.00
Lucent Health Facility/Professional Facility Modifier 52 Low / Median / High Price $663.66 / $716.72 / $716.72	Facility	52	$663.66	$716.72	$716.72
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $165.92 / $179.18 / $179.18	Facility	53	$165.92	$179.18	$179.18
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,182.00 / $2,206.53 / $2,836.73	Professional		$1,182.00	$2,206.53	$2,836.73
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $206.68	Professional		$32.34	$32.34	$206.68
Providence Facility/Professional Facility Modifier Low / Median / High Price $195.53 / $343.87 / $603.94	Facility		$195.53	$343.87	$603.94
Providence Facility/Professional Facility Modifier 52 Low / Median / High Price $194.61 / $194.61 / $194.61	Facility	52	$194.61	$194.61	$194.61
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $48.65 / $48.65 / $48.65	Facility	53	$48.65	$48.65	$48.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $301.45 / $301.45 / $853.41	Professional		$301.45	$301.45	$853.41
Providence Facility/Professional Professional Modifier 53 Low / Median / High Price $106.08 / $121.92 / $188.42	Professional	53	$106.08	$121.92	$188.42
Sutter Health Plus Facility/Professional Facility Modifier Low / Median / High Price $1,606.00 / $1,606.00 / $1,606.00	Facility		$1,606.00	$1,606.00	$1,606.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $603.37 / $603.37 / $1,092.65	Professional		$603.37	$603.37	$1,092.65
Sutter Health Plus Facility/Professional Professional Modifier 53 Low / Median / High Price $301.68 / $301.68 / $546.91	Professional	53	$301.68	$301.68	$546.91
United Facility/Professional Facility Modifier Low / Median / High Price $722.00 / $2,607.00 / $7,940.00	Facility		$722.00	$2,607.00	$7,940.00
United Facility/Professional Professional Modifier Low / Median / High Price $272.89 / $404.63 / $911.33	Professional		$272.89	$404.63	$911.33
United Facility/Professional Professional Modifier 53 Low / Median / High Price $92.98 / $204.61 / $204.61	Professional	53	$92.98	$204.61	$204.61