Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,989.00 / $6,014.00 / $12,464.00	Facility		$1,989.00	$6,014.00	$12,464.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,282.27 / $18,408.70 / $55,752.34	Facility		$1,282.27	$18,408.70	$55,752.34
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,603.26 / $2,119.73 / $2,923.76	Facility		$1,603.26	$2,119.73	$2,923.76
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,738.20 / $6,918.00 / $10,000.00	Facility		$1,738.20	$6,918.00	$10,000.00
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $1,073.02 / $1,073.02 / $1,073.02	Facility	62	$1,073.02	$1,073.02	$1,073.02
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $171.68 / $171.68 / $171.68	Facility	AS	$171.68	$171.68	$171.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,674.99 / $2,573.40 / $5,093.21	Professional		$1,674.99	$2,573.40	$5,093.21
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $4,529.47 / $4,529.47 / $4,529.47	Professional	22	$4,529.47	$4,529.47	$4,529.47
Kaiser Permanente Facility/Professional Professional Modifier 62 Low / Median / High Price $1,415.46 / $1,415.46 / $1,415.46	Professional	62	$1,415.46	$1,415.46	$1,415.46
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $120.79 / $120.79 / $120.79	Professional	80	$120.79	$120.79	$120.79
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $60.39 / $60.39 / $60.39	Professional	AS	$60.39	$60.39	$60.39
United Facility/Professional Facility Modifier Low / Median / High Price $2,303.00 / $10,242.00 / $28,629.00	Facility		$2,303.00	$10,242.00	$28,629.00