Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $724.50 / $4,592.00 / $14,247.75	Facility		$724.50	$4,592.00	$14,247.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $241.36 / $415.53 / $1,041.15	Professional		$241.36	$415.53	$1,041.15
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $34.50 / $62.47 / $172.98	Professional	AS	$34.50	$62.47	$172.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $247.65 / $371.46 / $517.64	Professional		$247.65	$371.46	$517.64
Ambetter Facility/Professional Professional Modifier AS Low / Median / High Price $40.40 / $59.44 / $75.95	Professional	AS	$40.40	$59.44	$75.95
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $7,875.00 / $22,373.24 / $26,321.46	Facility		$7,875.00	$22,373.24	$26,321.46
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $257.54 / $384.41 / $661.87	Professional		$257.54	$384.41	$661.87
Anthem BCBS Facility/Professional Professional Modifier AS Low / Median / High Price $36.04 / $53.81 / $92.66	Professional	AS	$36.04	$53.81	$92.66
CareSource Facility/Professional Facility Modifier Low / Median / High Price $270.16 / $357.98 / $495.28	Facility		$270.16	$357.98	$495.28
CareSource Facility/Professional Professional Modifier Low / Median / High Price $238.04 / $309.45 / $333.26	Professional		$238.04	$309.45	$333.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $292.55 / $292.55 / $2,575.00	Facility		$292.55	$292.55	$2,575.00
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $179.42 / $179.42 / $179.42	Facility	62	$179.42	$179.42	$179.42
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $28.71 / $28.71 / $28.71	Facility	AS	$28.71	$28.71	$28.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $286.30 / $423.51 / $665.00	Professional		$286.30	$423.51	$665.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $281.27 / $432.13 / $2,024.20	Professional		$281.27	$432.13	$2,024.20
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $760.60 / $760.60 / $760.60	Professional	22	$760.60	$760.60	$760.60
Kaiser Permanente Facility/Professional Professional Modifier 62 Low / Median / High Price $237.69 / $237.69 / $237.69	Professional	62	$237.69	$237.69	$237.69
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $20.28 / $20.28 / $20.28	Professional	80	$20.28	$20.28	$20.28
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $10.14 / $10.14 / $10.14	Professional	AS	$10.14	$10.14	$10.14
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $247.64 / $359.08 / $456.33	Professional		$247.64	$359.08	$456.33
United Facility/Professional Facility Modifier Low / Median / High Price $175.00 / $1,550.00 / $2,665.00	Facility		$175.00	$1,550.00	$2,665.00
United Facility/Professional Professional Modifier Low / Median / High Price $230.68 / $387.63 / $600.38	Professional		$230.68	$387.63	$600.38