Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,194.20 / $5,758.00 / $17,063.18	Facility		$3,194.20	$5,758.00	$17,063.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,311.36 / $1,637.07 / $3,810.48	Professional		$1,311.36	$1,637.07	$3,810.48
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $185.92 / $402.24 / $533.42	Professional	AS	$185.92	$402.24	$533.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $382.77 / $2,050.53 / $2,733.46	Professional		$382.77	$2,050.53	$2,733.46
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,206.31 / $6,369.70 / $32,952.16	Facility		$2,206.31	$6,369.70	$32,952.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,438.78 / $2,120.01 / $3,722.44	Professional		$1,438.78	$2,120.01	$3,722.44
Anthem BCBS Facility/Professional Professional Modifier AS Low / Median / High Price $201.42 / $296.80 / $521.14	Professional	AS	$201.42	$296.80	$521.14
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,506.73 / $2,075.14 / $3,565.04	Facility		$1,506.73	$2,075.14	$3,565.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,333.91 / $1,734.08 / $1,867.47	Professional		$1,333.91	$1,734.08	$1,867.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,636.45 / $1,636.45 / $22,500.00	Facility		$1,636.45	$1,636.45	$22,500.00
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $161.91 / $161.91 / $161.91	Facility	AS	$161.91	$161.91	$161.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,551.05 / $2,343.13 / $3,706.66	Professional		$1,551.05	$2,343.13	$3,706.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,574.24 / $2,296.13 / $4,562.37	Professional		$1,574.24	$2,296.13	$4,562.37
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $4,257.02 / $4,257.02 / $4,257.02	Professional	22	$4,257.02	$4,257.02	$4,257.02
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $113.52 / $113.52 / $113.52	Professional	80	$113.52	$113.52	$113.52
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $56.76 / $56.76 / $56.76	Professional	AS	$56.76	$56.76	$56.76
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $1,874.14 / $2,232.56 / $2,583.85	Professional		$1,874.14	$2,232.56	$2,583.85
United Facility/Professional Facility Modifier Low / Median / High Price $2,908.00 / $11,182.00 / $30,000.00	Facility		$2,908.00	$11,182.00	$30,000.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,298.66 / $2,113.44 / $3,314.76	Professional		$1,298.66	$2,113.44	$3,314.76