Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $248.75 / $2,987.00 / $6,915.00	Facility		$248.75	$2,987.00	$6,915.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $163.35 / $201.65 / $301.77	Facility	54	$163.35	$201.65	$301.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $196.43 / $248.75 / $543.28	Professional		$196.43	$248.75	$543.28
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 $215.23 / $304.20 / $557.79	Professional		$215.23	$304.20	$557.79
CareSource Facility/Professional Facility Modifier Low / Median / High Price $369.18 / $453.38 / $616.71	Facility		$369.18	$453.38	$616.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $177.38 / $362.57 / $2,500.00	Facility		$177.38	$362.57	$2,500.00
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $253.80 / $253.80 / $253.80	Facility	54	$253.80	$253.80	$253.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $217.42 / $327.79 / $575.41	Professional		$217.42	$327.79	$575.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $247.51 / $344.37 / $605.46	Professional		$247.51	$344.37	$605.46
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $298.77 / $298.77 / $339.06	Professional	54	$298.77	$298.77	$339.06
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $301.32 / $376.66 / $439.66	Professional		$301.32	$376.66	$439.66
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 $209.82 / $315.35 / $554.19	Professional		$209.82	$315.35	$554.19