Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,910.10 / $6,915.00 / $11,103.00	Facility		$2,910.10	$6,915.00	$11,103.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $740.80 / $1,274.07 / $1,643.44	Facility	52	$740.80	$1,274.07	$1,643.44
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,226.13 / $6,312.96 / $13,137.87	Facility		$2,226.13	$6,312.96	$13,137.87
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,167.03 / $1,578.95 / $1,748.12	Facility		$1,167.03	$1,578.95	$1,748.12
Cigna Facility/Professional Facility Modifier Low / Median / High Price $9,050.00 / $16,344.00 / $24,659.00	Facility		$9,050.00	$16,344.00	$24,659.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,167.03 / $1,517.14 / $4,621.06	Professional		$1,167.03	$1,517.14	$4,621.06
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $6,634.31 / $6,634.31 / $6,634.31	Professional	22	$6,634.31	$6,634.31	$6,634.31
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $1,935.01 / $1,935.01 / $1,935.01	Professional	52	$1,935.01	$1,935.01	$1,935.01
Kaiser Permanente Facility/Professional Professional Modifier 62 Low / Median / High Price $2,073.21 / $2,073.21 / $2,073.21	Professional	62	$2,073.21	$2,073.21	$2,073.21
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $176.91 / $176.91 / $176.91	Professional	80	$176.91	$176.91	$176.91
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $88.46 / $88.46 / $88.46	Professional	AS	$88.46	$88.46	$88.46
United Facility/Professional Facility Modifier Low / Median / High Price $2,303.00 / $10,133.00 / $20,037.00	Facility		$2,303.00	$10,133.00	$20,037.00