Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,646.34 / $5,063.00 / $7,631.00	Facility		$1,646.34	$5,063.00	$7,631.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,206.31 / $5,656.86 / $12,326.53	Facility		$2,206.31	$5,656.86	$12,326.53
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,832.81 / $1,832.81 / $1,832.81	Facility		$1,832.81	$1,832.81	$1,832.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,403.28 / $2,225.00 / $57,200.00	Facility		$1,403.28	$2,225.00	$57,200.00
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $139.43 / $139.43 / $139.43	Facility	AS	$139.43	$139.43	$139.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,425.43 / $2,092.51 / $4,328.04	Professional		$1,425.43	$2,092.51	$4,328.04
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $4,301.50 / $4,301.50 / $4,301.50	Professional	22	$4,301.50	$4,301.50	$4,301.50
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $114.71 / $114.71 / $114.71	Professional	80	$114.71	$114.71	$114.71
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $57.35 / $57.35 / $57.35	Professional	AS	$57.35	$57.35	$57.35
United Facility/Professional Facility Modifier Low / Median / High Price $1,998.00 / $9,193.00 / $18,613.00	Facility		$1,998.00	$9,193.00	$18,613.00