Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $204.96 / $204.96 / $207.00	Facility		$204.96	$204.96	$207.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.96 / $204.96 / $225.45	Professional		$204.96	$204.96	$225.45
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $229.20 / $272.89 / $461.71	Facility		$229.20	$272.89	$461.71
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.96 / $255.14 / $696.25	Professional		$204.96	$255.14	$696.25
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Facility		$100.00	$100.00	$100.00
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $256.94 / $367.05 / $754.54	Professional		$256.94	$367.05	$754.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $193.35 / $193.35 / $204.96	Facility		$193.35	$193.35	$204.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.96 / $204.96 / $343.00	Professional		$204.96	$204.96	$343.00
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $175.45 / $263.35 / $355.52	Professional		$175.45	$263.35	$355.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $184.46 / $256.20 / $469.00	Professional		$184.46	$256.20	$469.00
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $1,076.67 / $1,266.67 / $1,266.67	Facility		$1,076.67	$1,266.67	$1,266.67
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,778.96 / $1,778.96 / $1,778.96	Professional		$1,778.96	$1,778.96	$1,778.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $192.99 / $539.86 / $539.86	Professional		$192.99	$539.86	$539.86
Providence Facility/Professional Facility Modifier Low / Median / High Price $204.96 / $225.94 / $363.75	Facility		$204.96	$225.94	$363.75
Providence Facility/Professional Professional Modifier Low / Median / High Price $204.96 / $204.96 / $460.13	Professional		$204.96	$204.96	$460.13
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $163.96 / $175.45 / $225.45	Professional		$163.96	$175.45	$225.45
United Facility/Professional Professional Modifier Low / Median / High Price $204.96 / $204.96 / $436.52	Professional		$204.96	$204.96	$436.52