Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $319.26 / $2,595.00 / $6,915.00	Facility		$319.26	$2,595.00	$6,915.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $224.15 / $359.55 / $450.74	Facility	54	$224.15	$359.55	$450.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $274.54 / $337.71 / $680.02	Professional		$274.54	$337.71	$680.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $380.35 / $380.35 / $399.81	Professional		$380.35	$380.35	$399.81
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 $297.87 / $431.91 / $772.30	Professional		$297.87	$431.91	$772.30
CareSource Facility/Professional Facility Modifier Low / Median / High Price $508.20 / $627.45 / $867.83	Facility		$508.20	$627.45	$867.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $177.38 / $498.64 / $640.00	Facility		$177.38	$498.64	$640.00
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $349.05 / $349.05 / $349.05	Facility	54	$349.05	$349.05	$349.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $308.76 / $478.41 / $770.16	Professional		$308.76	$478.41	$770.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $342.55 / $471.61 / $785.54	Professional		$342.55	$471.61	$785.54
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $413.49 / $413.49 / $439.90	Professional	54	$413.49	$413.49	$439.90
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $481.20 / $554.13 / $586.25	Professional		$481.20	$554.13	$586.25
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 $266.88 / $479.37 / $749.28	Professional		$266.88	$479.37	$749.28