Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $275.14 / $2,987.00 / $6,915.00	Facility		$275.14	$2,987.00	$6,915.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $191.06 / $218.51 / $330.47	Facility	54	$191.06	$218.51	$330.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $221.68 / $281.16 / $601.74	Professional		$221.68	$281.16	$601.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $329.63 / $360.68 / $394.33	Professional		$329.63	$360.68	$394.33
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $734.14 / $2,139.92 / $4,143.39	Facility		$734.14	$2,139.92	$4,143.39
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $245.14 / $351.88 / $644.10	Professional		$245.14	$351.88	$644.10
CareSource Facility/Professional Facility Modifier Low / Median / High Price $437.34 / $539.37 / $733.71	Facility		$437.34	$539.37	$733.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $177.38 / $428.72 / $2,500.00	Facility		$177.38	$428.72	$2,500.00
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $300.10 / $300.10 / $300.10	Facility	54	$300.10	$300.10	$300.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $238.70 / $373.69 / $654.46	Professional		$238.70	$373.69	$654.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $294.47 / $404.28 / $680.31	Professional		$294.47	$404.28	$680.31
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $355.45 / $355.45 / $380.97	Professional	54	$355.45	$355.45	$380.97
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $403.38 / $456.97 / $507.71	Professional		$403.38	$456.97	$507.71
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 $226.61 / $344.96 / $617.78	Professional		$226.61	$344.96	$617.78