Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $101.49 / $102.94 / $149.19	Facility		$101.49	$102.94	$149.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $101.49 / $102.94 / $122.80	Professional		$101.49	$102.94	$122.80
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $102.93 / $167.57 / $377.75	Facility		$102.93	$167.57	$377.75
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.94 / $102.94 / $102.94	Professional		$102.94	$102.94	$102.94
CareSource Facility/Professional Facility Modifier Low / Median / High Price $102.94 / $102.94 / $201.76	Facility		$102.94	$102.94	$201.76
Cigna Facility/Professional Facility Modifier Low / Median / High Price $97.11 / $97.11 / $102.94	Facility		$97.11	$97.11	$102.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.94 / $102.94 / $102.94	Professional		$102.94	$102.94	$102.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $124.25 / $383.00 / $594.00	Professional		$124.25	$383.00	$594.00
United Facility/Professional Professional Modifier Low / Median / High Price $102.94 / $102.94 / $157.50	Professional		$102.94	$102.94	$157.50