Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $300.36 / $2,760.00 / $6,915.00	Facility		$300.36	$2,760.00	$6,915.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $200.74 / $225.27 / $359.09	Facility	54	$200.74	$225.27	$359.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $243.00 / $301.80 / $631.65	Professional		$243.00	$301.80	$631.65
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 $256.95 / $368.76 / $664.96	Professional		$256.95	$368.76	$664.96
CareSource Facility/Professional Facility Modifier Low / Median / High Price $460.26 / $566.21 / $770.21	Facility		$460.26	$566.21	$770.21
Cigna Facility/Professional Facility Modifier Low / Median / High Price $177.38 / $451.20 / $2,500.00	Facility		$177.38	$451.20	$2,500.00
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $315.83 / $315.83 / $315.83	Facility	54	$315.83	$315.83	$315.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $250.47 / $390.43 / $687.55	Professional		$250.47	$390.43	$687.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $309.11 / $423.13 / $744.63	Professional		$309.11	$423.13	$744.63
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $373.12 / $373.12 / $416.99	Professional	54	$373.12	$373.12	$416.99
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $376.31 / $464.77 / $563.35	Professional		$376.31	$464.77	$563.35
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 $243.76 / $367.66 / $678.91	Professional		$243.76	$367.66	$678.91