Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,707.11 / $1,707.11 / $1,707.11	Facility		$1,707.11	$1,707.11	$1,707.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,645.41 / $1,707.11 / $1,707.11	Professional		$1,645.41	$1,707.11	$1,707.11
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $802.34 / $1,713.97 / $2,944.59	Facility		$802.34	$1,713.97	$2,944.59
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,568.52 / $1,655.66 / $1,713.97	Professional		$1,568.52	$1,655.66	$1,713.97
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,748.25 / $1,799.67 / $3,509.45	Facility		$1,748.25	$1,799.67	$3,509.45
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,748.25 / $1,748.25 / $1,748.25	Facility		$1,748.25	$1,748.25	$1,748.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,748.25 / $1,748.25 / $1,748.25	Professional		$1,748.25	$1,748.25	$1,748.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,748.25 / $2,636.00 / $4,084.00	Professional		$1,748.25	$2,636.00	$4,084.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $459.59 / $643.42 / $702.22	Professional		$459.59	$643.42	$702.22
United Facility/Professional Professional Modifier Low / Median / High Price $1,713.97 / $1,713.97 / $2,056.76	Professional		$1,713.97	$1,713.97	$2,056.76