Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $295.79 / $646.58 / $6,915.00	Facility		$295.79	$646.58	$6,915.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $221.84 / $233.98 / $373.88	Facility	54	$221.84	$233.98	$373.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $259.08 / $319.12 / $695.39	Professional		$259.08	$319.12	$695.39
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $194.91 / $233.98 / $511.18	Professional	54	$194.91	$233.98	$511.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $304.92 / $384.40 / $549.42	Professional		$304.92	$384.40	$549.42
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 $253.30 / $397.06 / $732.49	Professional		$253.30	$397.06	$732.49
CareSource Facility/Professional Facility Modifier Low / Median / High Price $379.52 / $379.52 / $379.52	Facility		$379.52	$379.52	$379.52
Cigna Facility/Professional Facility Modifier Low / Median / High Price $177.38 / $497.70 / $2,500.00	Facility		$177.38	$497.70	$2,500.00
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $348.39 / $348.39 / $348.39	Facility	54	$348.39	$348.39	$348.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $264.29 / $405.91 / $753.03	Professional		$264.29	$405.91	$753.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $342.07 / $402.72 / $772.52	Professional		$342.07	$402.72	$772.52
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $412.91 / $412.91 / $432.61	Professional	54	$412.91	$412.91	$432.61
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $394.29 / $476.68 / $554.24	Professional		$394.29	$476.68	$554.24
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 $249.03 / $367.61 / $701.84	Professional		$249.03	$367.61	$701.84