Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $4,365.16 / $10,964.78 / $25,118.86	Facility		$4,365.16	$10,964.78	$25,118.86
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $15,135.61 / $15,135.61 / $15,135.61	Facility	22	$15,135.61	$15,135.61	$15,135.61
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $17,782.79 / $17,782.79 / $66,069.34	Facility	50	$17,782.79	$17,782.79	$66,069.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $1,479.11 / $3,715.35	Professional		$575.44	$1,479.11	$3,715.35
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $158.49 / $323.59 / $660.69	Professional	AS	$158.49	$323.59	$660.69
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $1,318.26 / $2,238.72	Professional		$165.96	$1,318.26	$2,238.72
Ambetter Facility/Professional Professional Modifier AS Low / Median / High Price $295.12 / $295.12 / $295.12	Professional	AS	$295.12	$295.12	$295.12
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,238.72 / $6,456.54 / $20,892.96	Facility		$2,238.72	$6,456.54	$20,892.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,513.56 / $2,344.23 / $3,162.28	Professional		$1,513.56	$2,344.23	$3,162.28
Anthem BCBS Facility/Professional Professional Modifier AS Low / Median / High Price $218.78 / $323.59 / $446.68	Professional	AS	$218.78	$323.59	$446.68
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,513.56 / $1,819.70 / $2,511.89	Facility		$1,513.56	$1,819.70	$2,511.89
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,513.56 / $1,778.28	Professional		$1,174.90	$1,513.56	$1,778.28
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,187.76 / $12,589.25 / $53,703.18	Facility		$2,187.76	$12,589.25	$53,703.18
Cigna Facility/Professional Facility Modifier 22 Low / Median / High Price $2,630.27 / $2,630.27 / $2,630.27	Facility	22	$2,630.27	$2,630.27	$2,630.27
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $1,513.56 / $1,513.56 / $1,513.56	Facility	54	$1,513.56	$1,513.56	$1,513.56
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $218.78 / $218.78 / $218.78	Facility	AS	$218.78	$218.78	$218.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,513.56 / $2,137.96 / $3,388.44	Professional		$1,513.56	$2,137.96	$3,388.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $2,041.74 / $10,232.93	Professional		$1,318.26	$2,041.74	$10,232.93
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $3,801.89 / $3,801.89 / $3,801.89	Professional	22	$3,801.89	$3,801.89	$3,801.89
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $1,778.28 / $1,778.28 / $1,778.28	Professional	54	$1,778.28	$1,778.28	$1,778.28
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $100.00 / $100.00 / $100.00	Professional	80	$100.00	$100.00	$100.00
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $50.12 / $50.12 / $50.12	Professional	AS	$50.12	$50.12	$50.12
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $1,995.26 / $2,238.72 / $2,238.72	Professional		$1,995.26	$2,238.72	$2,238.72
United Facility/Professional Facility Modifier Low / Median / High Price $2,884.03 / $10,000.00 / $25,118.86	Facility		$2,884.03	$10,000.00	$25,118.86
United Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,949.84 / $3,019.95	Professional		$1,202.26	$1,949.84	$3,019.95