Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $614.11 / $3,391.00 / $6,915.00	Facility		$614.11	$3,391.00	$6,915.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $964.00 / $2,909.20 / $15,318.85	Facility		$964.00	$2,909.20	$15,318.85
CareSource Facility/Professional Facility Modifier Low / Median / High Price $602.66 / $602.66 / $602.66	Facility		$602.66	$602.66	$602.66
Cigna Facility/Professional Facility Modifier Low / Median / High Price $408.17 / $5,845.00 / $9,852.00	Facility		$408.17	$5,845.00	$9,852.00
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $250.26 / $250.26 / $250.26	Facility	62	$250.26	$250.26	$250.26
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $40.04 / $40.04 / $40.04	Facility	AS	$40.04	$40.04	$40.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $391.42 / $601.37 / $1,154.16	Professional		$391.42	$601.37	$1,154.16
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $1,058.48 / $1,058.48 / $1,058.48	Professional	22	$1,058.48	$1,058.48	$1,058.48
Kaiser Permanente Facility/Professional Professional Modifier 62 Low / Median / High Price $330.78 / $330.78 / $330.78	Professional	62	$330.78	$330.78	$330.78
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $28.23 / $28.23 / $28.23	Professional	80	$28.23	$28.23	$28.23
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $14.11 / $14.11 / $14.11	Professional	AS	$14.11	$14.11	$14.11
United Facility/Professional Facility Modifier Low / Median / High Price $175.00 / $1,800.00 / $24,000.00	Facility		$175.00	$1,800.00	$24,000.00