Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $4,507.00 / $9,784.96 / $24,986.00	Facility		$4,507.00	$9,784.96	$24,986.00
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $15,301.00 / $15,301.00 / $15,301.00	Facility	22	$15,301.00	$15,301.00	$15,301.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $14,322.00 / $17,805.00 / $66,826.78	Facility	50	$14,322.00	$17,805.00	$66,826.78
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $989.83 / $1,627.10 / $2,115.29	Facility	54	$989.83	$1,627.10	$2,115.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,137.89 / $1,465.05 / $4,180.93	Professional		$1,137.89	$1,465.05	$4,180.93
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $153.44 / $283.27 / $532.77	Professional	AS	$153.44	$283.27	$532.77
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $330.58 / $1,738.62 / $2,362.76	Professional		$330.58	$1,738.62	$2,362.76
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,226.13 / $9,454.90 / $32,952.16	Facility		$2,226.13	$9,454.90	$32,952.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,278.28 / $2,049.60 / $3,712.35	Professional		$1,278.28	$2,049.60	$3,712.35
Anthem BCBS Facility/Professional Professional Modifier AS Low / Median / High Price $178.95 / $286.94 / $517.19	Professional	AS	$178.95	$286.94	$517.19
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,339.61 / $1,845.31 / $3,646.55	Facility		$1,339.61	$1,845.31	$3,646.55
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,185.56 / $1,541.23 / $1,659.78	Professional		$1,185.56	$1,541.23	$1,659.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,453.24 / $12,733.72 / $52,000.00	Facility		$1,453.24	$12,733.72	$52,000.00
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $1,006.58 / $1,006.58 / $1,006.58	Facility	54	$1,006.58	$1,006.58	$1,006.58
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $143.80 / $143.80 / $143.80	Facility	AS	$143.80	$143.80	$143.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,525.10 / $2,303.80 / $3,495.63	Professional		$1,525.10	$2,303.80	$3,495.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,399.89 / $2,150.73 / $7,108.45	Professional		$1,399.89	$2,150.73	$7,108.45
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $3,785.54 / $3,785.54 / $3,785.54	Professional	22	$3,785.54	$3,785.54	$3,785.54
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $1,766.59 / $1,766.59 / $1,766.59	Professional	54	$1,766.59	$1,766.59	$1,766.59
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $100.95 / $100.95 / $100.95	Professional	80	$100.95	$100.95	$100.95
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $50.47 / $50.47 / $50.47	Professional	AS	$50.47	$50.47	$50.47
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $1,272.63 / $1,943.69 / $2,271.19	Professional		$1,272.63	$1,943.69	$2,271.19
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 $1,201.28 / $2,018.65 / $3,093.98	Professional		$1,201.28	$2,018.65	$3,093.98