Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $238.15 / $2,595.00 / $5,597.76	Facility		$238.15	$2,595.00	$5,597.76
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $117.09 / $147.71 / $238.39	Facility	54	$117.09	$147.71	$238.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $156.12 / $204.98 / $401.12	Professional		$156.12	$204.98	$401.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $213.85 / $357.55 / $377.08	Professional		$213.85	$357.55	$377.08
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $734.14 / $2,080.80 / $3,851.83	Facility		$734.14	$2,080.80	$3,851.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $174.10 / $244.76 / $446.82	Professional		$174.10	$244.76	$446.82
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $261.14 / $367.14 / $670.23	Professional	50	$261.14	$367.14	$670.23
CareSource Facility/Professional Facility Modifier Low / Median / High Price $170.42 / $216.98 / $653.28	Facility		$170.42	$216.98	$653.28
CareSource Facility/Professional Professional Modifier Low / Median / High Price $195.56 / $230.12 / $242.50	Professional		$195.56	$230.12	$242.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $159.62 / $248.67 / $466.12	Professional		$159.62	$248.67	$466.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $198.90 / $230.12 / $430.72	Professional		$198.90	$230.12	$430.72
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $170.12 / $170.12 / $196.82	Professional	54	$170.12	$170.12	$196.82
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,647.62 / $1,797.31 / $5,938.87	Facility		$1,647.62	$1,797.31	$5,938.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $194.84 / $275.97 / $354.06	Professional		$194.84	$275.97	$354.06
United Facility/Professional Facility Modifier Low / Median / High Price $353.00 / $1,580.00 / $2,665.00	Facility		$353.00	$1,580.00	$2,665.00
United Facility/Professional Professional Modifier Low / Median / High Price $176.45 / $247.68 / $479.13	Professional		$176.45	$247.68	$479.13