Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $251.21 / $2,800.00 / $6,915.00	Facility		$251.21	$2,800.00	$6,915.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $182.87 / $206.13 / $309.88	Facility	54	$182.87	$206.13	$309.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $210.00 / $258.07 / $533.48	Professional		$210.00	$258.07	$533.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $240.58 / $240.58 / $240.58	Professional		$240.58	$240.58	$240.58
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $635.46 / $2,067.41 / $3,851.83	Facility		$635.46	$2,067.41	$3,851.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $226.90 / $349.05 / $643.86	Professional		$226.90	$349.05	$643.86
CareSource Facility/Professional Facility Modifier Low / Median / High Price $431.00 / $507.05 / $721.83	Facility		$431.00	$507.05	$721.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $177.38 / $278.24 / $640.00	Facility		$177.38	$278.24	$640.00
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $192.34 / $192.34 / $192.34	Facility	54	$192.34	$192.34	$192.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.93 / $353.71 / $622.00	Professional		$229.93	$353.71	$622.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $277.11 / $340.90 / $624.44	Professional		$277.11	$340.90	$624.44
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $338.05 / $338.05 / $349.69	Professional	54	$338.05	$338.05	$349.69
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $345.88 / $400.89 / $451.57	Professional		$345.88	$400.89	$451.57
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 $204.93 / $306.44 / $548.66	Professional		$204.93	$306.44	$548.66