Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,237.28 / $1,237.28 / $1,249.66	Facility		$1,237.28	$1,237.28	$1,249.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,237.28 / $1,237.28 / $1,361.01	Professional		$1,237.28	$1,237.28	$1,361.01
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $103.85 / $123.65 / $209.21	Facility		$103.85	$123.65	$209.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $106.56 / $199.26 / $1,914.29	Professional		$106.56	$199.26	$1,914.29
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 $100.00 / $100.00 / $989.82	Professional		$100.00	$100.00	$989.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,167.25 / $1,167.25 / $1,237.28	Facility		$1,167.25	$1,167.25	$1,237.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,237.28 / $1,237.28 / $1,428.00	Professional		$1,237.28	$1,237.28	$1,428.00
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $1,159.60 / $1,275.58 / $1,565.48	Professional		$1,159.60	$1,275.58	$1,565.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,113.55 / $1,546.60 / $2,722.02	Professional		$1,113.55	$1,546.60	$2,722.02
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $1,428.00 / $2,408.92 / $5,119.78	Facility		$1,428.00	$2,408.92	$5,119.78
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,119.78 / $5,119.78 / $5,563.22	Professional		$5,119.78	$5,119.78	$5,563.22
Molina Facility/Professional Professional Modifier Low / Median / High Price $70.00 / $1,565.47 / $2,377.20	Professional		$70.00	$1,565.47	$2,377.20
Providence Facility/Professional Facility Modifier Low / Median / High Price $1,237.28 / $1,361.01 / $2,106.79	Facility		$1,237.28	$1,361.01	$2,106.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,237.28 / $1,237.28 / $1,680.00	Professional		$1,237.28	$1,237.28	$1,680.00
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $989.83 / $1,159.60 / $1,391.53	Professional		$989.83	$1,159.60	$1,391.53
United Facility/Professional Professional Modifier Low / Median / High Price $1,237.28 / $1,237.28 / $2,376.81	Professional		$1,237.28	$1,237.28	$2,376.81