Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $194.91 / $662.40 / $6,915.00	Facility		$194.91	$662.40	$6,915.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $145.38 / $152.55 / $244.95	Facility	54	$145.38	$152.55	$244.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $163.07 / $203.62 / $454.75	Professional		$163.07	$203.62	$454.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $192.77 / $192.77 / $374.67	Professional		$192.77	$192.77	$374.67
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 $176.54 / $269.87 / $488.54	Professional		$176.54	$269.87	$488.54
CareSource Facility/Professional Facility Modifier Low / Median / High Price $257.60 / $257.60 / $257.60	Facility		$257.60	$257.60	$257.60
Cigna Facility/Professional Facility Modifier Low / Median / High Price $172.22 / $224.31 / $2,500.00	Facility		$172.22	$224.31	$2,500.00
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $154.76 / $154.76 / $154.76	Facility	54	$154.76	$154.76	$154.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $179.62 / $278.94 / $491.91	Professional		$179.62	$278.94	$491.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $218.26 / $258.41 / $491.86	Professional		$218.26	$258.41	$491.86
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $272.31 / $272.31 / $275.44	Professional	54	$272.31	$272.31	$275.44
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $257.39 / $309.54 / $354.11	Professional		$257.39	$309.54	$354.11
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 $161.21 / $239.22 / $441.16	Professional		$161.21	$239.22	$441.16