Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $317.18 / $4,467.00 / $6,915.00	Facility		$317.18	$4,467.00	$6,915.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $237.89 / $276.79 / $425.91	Facility	54	$237.89	$276.79	$425.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $271.52 / $342.85 / $708.26	Professional		$271.52	$342.85	$708.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $279.20 / $279.20 / $279.20	Professional		$279.20	$279.20	$279.20
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 $298.36 / $438.90 / $811.36	Professional		$298.36	$438.90	$811.36
CareSource Facility/Professional Facility Modifier Low / Median / High Price $541.73 / $664.55 / $903.99	Facility		$541.73	$664.55	$903.99
Cigna Facility/Professional Facility Modifier Low / Median / High Price $177.38 / $530.78 / $2,500.00	Facility		$177.38	$530.78	$2,500.00
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $371.55 / $371.55 / $371.55	Facility	54	$371.55	$371.55	$371.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $298.00 / $466.97 / $816.21	Professional		$298.00	$466.97	$816.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $362.80 / $504.11 / $841.18	Professional		$362.80	$504.11	$841.18
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $437.93 / $437.93 / $471.06	Professional	54	$437.93	$437.93	$471.06
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $429.44 / $529.38 / $627.78	Professional		$429.44	$529.38	$627.78
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 $286.41 / $423.55 / $764.23	Professional		$286.41	$423.55	$764.23