Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $494.00 / $2,572.00 / $7,421.00	Facility		$494.00	$2,572.00	$7,421.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $184.71 / $246.81 / $982.90	Professional		$184.71	$246.81	$982.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $174.17 / $174.17 / $230.84	Professional		$174.17	$174.17	$230.84
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $7,875.00 / $7,875.00 / $7,875.00	Facility		$7,875.00	$7,875.00	$7,875.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $212.22 / $282.25 / $511.81	Professional		$212.22	$282.25	$511.81
CareSource Facility/Professional Facility Modifier Low / Median / High Price $202.94 / $252.62 / $644.95	Facility		$202.94	$252.62	$644.95
CareSource Facility/Professional Professional Modifier Low / Median / High Price $202.94 / $231.57 / $239.81	Professional		$202.94	$231.57	$239.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $176.25 / $270.45 / $454.73	Professional		$176.25	$270.45	$454.73
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $231.57 / $263.82 / $1,112.00	Professional		$231.57	$263.82	$1,112.00
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $424.44 / $424.44 / $424.44	Professional	22	$424.44	$424.44	$424.44
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $123.80 / $123.80 / $123.80	Professional	52	$123.80	$123.80	$123.80
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $11.32 / $11.32 / $11.32	Professional	80	$11.32	$11.32	$11.32
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $5.66 / $5.66 / $5.66	Professional	AS	$5.66	$5.66	$5.66
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $255.79 / $308.35 / $370.38	Professional		$255.79	$308.35	$370.38
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 $193.57 / $316.45 / $501.81	Professional		$193.57	$316.45	$501.81