Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,216.30 / $5,063.00 / $6,915.00	Facility		$1,216.30	$5,063.00	$6,915.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $608.15 / $933.71 / $1,156.86	Facility	52	$608.15	$933.71	$1,156.86
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $243.26 / $373.48 / $462.75	Facility	53	$243.26	$373.48	$462.75
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $659.95 / $3,801.18 / $10,304.31	Facility		$659.95	$3,801.18	$10,304.31
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,760.06 / $1,760.06 / $1,760.06	Facility		$1,760.06	$1,760.06	$1,760.06
Cigna Facility/Professional Facility Modifier Low / Median / High Price $200.00 / $617.00 / $1,233.00	Facility		$200.00	$617.00	$1,233.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $1,091.32 / $1,091.32 / $1,091.32	Facility	52	$1,091.32	$1,091.32	$1,091.32
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $272.83 / $272.83 / $272.83	Facility	53	$272.83	$272.83	$272.83
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $136.41 / $136.41 / $136.41	Facility	AS	$136.41	$136.41	$136.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,210.03 / $1,573.04 / $2,832.83	Professional		$1,210.03	$1,573.04	$2,832.83
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $3,399.40 / $3,399.40 / $4,339.22	Professional	22	$3,399.40	$3,399.40	$4,339.22
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $991.49 / $991.49 / $1,265.60	Professional	52	$991.49	$991.49	$1,265.60
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $991.49 / $991.49 / $1,645.29	Professional	53	$991.49	$991.49	$1,645.29
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $90.65 / $90.65 / $115.71	Professional	80	$90.65	$90.65	$115.71
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $45.33 / $45.33 / $57.86	Professional	AS	$45.33	$45.33	$57.86
United Facility/Professional Facility Modifier Low / Median / High Price $400.00 / $2,969.00 / $9,079.00	Facility		$400.00	$2,969.00	$9,079.00