Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $4,592.00 / $11,870.00 / $24,729.00	Facility		$4,592.00	$11,870.00	$24,729.00
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $50,000.00 / $50,000.00 / $50,000.00	Facility	22	$50,000.00	$50,000.00	$50,000.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $8,709.79 / $23,440.00 / $23,440.00	Facility	50	$8,709.79	$23,440.00	$23,440.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $991.10 / $1,515.58 / $1,975.66	Facility	54	$991.10	$1,515.58	$1,975.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,139.09 / $1,466.47 / $3,898.03	Professional		$1,139.09	$1,466.47	$3,898.03
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $165.03 / $331.54 / $895.79	Professional	AS	$165.03	$331.54	$895.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,139.40 / $1,745.76 / $2,433.87	Professional		$1,139.40	$1,745.76	$2,433.87
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,206.31 / $9,233.24 / $32,952.16	Facility		$2,206.31	$9,233.24	$32,952.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,280.33 / $1,996.96 / $3,471.53	Professional		$1,280.33	$1,996.96	$3,471.53
Anthem BCBS Facility/Professional Professional Modifier AS Low / Median / High Price $179.24 / $279.37 / $486.01	Professional	AS	$179.24	$279.37	$486.01
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,341.29 / $1,847.71 / $3,392.45	Facility		$1,341.29	$1,847.71	$3,392.45
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,186.99 / $1,543.09 / $1,661.79	Professional		$1,186.99	$1,543.09	$1,661.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,455.37 / $12,999.85 / $52,000.00	Facility		$1,455.37	$12,999.85	$52,000.00
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $1,008.15 / $1,008.15 / $1,008.15	Facility	54	$1,008.15	$1,008.15	$1,008.15
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $900.13 / $900.13 / $900.13	Facility	62	$900.13	$900.13	$900.13
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $144.02 / $144.02 / $144.02	Facility	AS	$144.02	$144.02	$144.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,503.59 / $2,248.71 / $3,479.56	Professional		$1,503.59	$2,248.71	$3,479.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,401.71 / $2,138.85 / $7,117.59	Professional		$1,401.71	$2,138.85	$7,117.59
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $3,790.48 / $3,790.48 / $3,790.48	Professional	22	$3,790.48	$3,790.48	$3,790.48
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $1,768.89 / $1,768.89 / $1,768.89	Professional	54	$1,768.89	$1,768.89	$1,768.89
Kaiser Permanente Facility/Professional Professional Modifier 62 Low / Median / High Price $1,184.52 / $1,184.52 / $1,184.52	Professional	62	$1,184.52	$1,184.52	$1,184.52
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $101.08 / $101.08 / $101.08	Professional	80	$101.08	$101.08	$101.08
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $50.54 / $50.54 / $50.54	Professional	AS	$50.54	$50.54	$50.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $1,274.28 / $1,948.27 / $2,274.13	Professional		$1,274.28	$1,948.27	$2,274.13
United Facility/Professional Facility Modifier Low / Median / High Price $2,908.00 / $16,710.00 / $28,629.00	Facility		$2,908.00	$16,710.00	$28,629.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,202.81 / $1,960.86 / $3,097.82	Professional		$1,202.81	$1,960.86	$3,097.82