Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,800.00 / $7,275.66 / $18,922.00	Facility		$2,800.00	$7,275.66	$18,922.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,226.13 / $7,532.09 / $23,994.42	Facility		$2,226.13	$7,532.09	$23,994.42
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,791.85 / $2,372.94 / $3,273.04	Facility		$1,791.85	$2,372.94	$3,273.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,938.95 / $1,938.95 / $12,477.02	Facility		$1,938.95	$1,938.95	$12,477.02
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $1,200.02 / $1,200.02 / $1,200.02	Facility	62	$1,200.02	$1,200.02	$1,200.02
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $192.00 / $192.00 / $192.00	Facility	AS	$192.00	$192.00	$192.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,876.29 / $2,882.67 / $9,445.00	Professional		$1,876.29	$2,882.67	$9,445.00
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $5,073.82 / $5,073.82 / $5,073.82	Professional	22	$5,073.82	$5,073.82	$5,073.82
Kaiser Permanente Facility/Professional Professional Modifier 62 Low / Median / High Price $1,585.57 / $1,585.57 / $1,585.57	Professional	62	$1,585.57	$1,585.57	$1,585.57
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $135.30 / $135.30 / $135.30	Professional	80	$135.30	$135.30	$135.30
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $67.65 / $67.65 / $67.65	Professional	AS	$67.65	$67.65	$67.65
United Facility/Professional Facility Modifier Low / Median / High Price $2,725.00 / $11,000.00 / $23,898.00	Facility		$2,725.00	$11,000.00	$23,898.00