Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $514.41 / $4,677.00 / $16,125.00	Facility		$514.41	$4,677.00	$16,125.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $94.71 / $180.09 / $881.54	Facility	52	$94.71	$180.09	$881.54
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $37.88 / $87.81 / $416.62	Facility	53	$37.88	$87.81	$416.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.09 / $294.62 / $1,001.30	Professional		$180.09	$294.62	$1,001.30
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $44.01 / $100.83 / $286.33	Professional	53	$44.01	$100.83	$286.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $163.95 / $182.91 / $369.15	Professional		$163.95	$182.91	$369.15
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $82.11 / $140.08 / $552.40	Professional	53	$82.11	$140.08	$552.40
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 $225.40 / $404.75 / $871.71	Professional		$225.40	$404.75	$871.71
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $95.04 / $179.34 / $362.96	Professional	53	$95.04	$179.34	$362.96
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 $198.09 / $359.13 / $704.30	Professional		$198.09	$359.13	$704.30
Blue Shield Facility/Professional Professional Modifier 53 Low / Median / High Price $100.00 / $306.89 / $590.49	Professional	53	$100.00	$306.89	$590.49
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 $194.94 / $194.94 / $194.94	Facility	52	$194.94	$194.94	$194.94
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $48.74 / $48.74 / $48.74	Facility	53	$48.74	$48.74	$48.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.75 / $301.75 / $324.18	Professional		$301.75	$301.75	$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 $203.22 / $416.66 / $562.49	Professional		$203.22	$416.66	$562.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $182.91 / $345.70 / $626.30	Professional		$182.91	$345.70	$626.30
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $101.61 / $187.50 / $316.66	Professional	53	$101.61	$187.50	$316.66
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $1,040.30 / $1,065.09 / $16,394.00	Facility		$1,040.30	$1,065.09	$16,394.00
Lucent Health Facility/Professional Facility Modifier 52 Low / Median / High Price $664.86 / $717.55 / $717.55	Facility	52	$664.86	$717.55	$717.55
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $166.21 / $179.39 / $179.39	Facility	53	$166.21	$179.39	$179.39
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,182.76 / $2,208.13 / $2,840.70	Professional		$1,182.76	$2,208.13	$2,840.70
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 $196.00 / $342.58 / $604.16	Facility		$196.00	$342.58	$604.16
Providence Facility/Professional Facility Modifier 52 Low / Median / High Price $194.94 / $194.94 / $194.94	Facility	52	$194.94	$194.94	$194.94
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $48.74 / $48.74 / $48.74	Facility	53	$48.74	$48.74	$48.74
Providence Facility/Professional Professional Modifier Low / Median / High Price $301.75 / $301.75 / $849.15	Professional		$301.75	$301.75	$849.15
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 $604.66 / $604.66 / $1,093.94	Professional		$604.66	$604.66	$1,093.94
Sutter Health Plus Facility/Professional Professional Modifier 53 Low / Median / High Price $302.33 / $302.33 / $547.57	Professional	53	$302.33	$302.33	$547.57
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 $273.47 / $405.48 / $1,000.58	Professional		$273.47	$405.48	$1,000.58
United Facility/Professional Professional Modifier 53 Low / Median / High Price $92.98 / $204.84 / $204.84	Professional	53	$92.98	$204.84	$204.84