Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $304.08 / $2,422.00 / $6,321.92	Facility		$304.08	$2,422.00	$6,321.92
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $60.59 / $152.05 / $296.17	Facility	52	$60.59	$152.05	$296.17
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $24.23 / $60.82 / $2,437.82	Facility	53	$24.23	$60.82	$2,437.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.17 / $294.44 / $677.36	Professional		$118.17	$294.44	$677.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $105.37 / $163.41 / $218.26	Professional		$105.37	$163.41	$218.26
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $450.00 / $1,635.81 / $3,784.98	Facility		$450.00	$1,635.81	$3,784.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $159.37 / $318.72 / $623.53	Professional		$159.37	$318.72	$623.53
CareSource Facility/Professional Facility Modifier Low / Median / High Price $119.06 / $159.97 / $190.50	Facility		$119.06	$159.97	$190.50
CareSource Facility/Professional Professional Modifier Low / Median / High Price $253.94 / $320.19 / $413.19	Professional		$253.94	$320.19	$413.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $334.00 / $535.00 / $652.00	Facility		$334.00	$535.00	$652.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $165.11 / $165.11 / $165.11	Facility	52	$165.11	$165.11	$165.11
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $41.28 / $41.28 / $41.28	Facility	53	$41.28	$41.28	$41.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $155.44 / $305.61 / $599.14	Professional		$155.44	$305.61	$599.14
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $136.91 / $318.27 / $599.82	Professional		$136.91	$318.27	$599.82
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $334.48 / $426.94 / $777.50	Professional	22	$334.48	$426.94	$777.50
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $97.56 / $124.52 / $226.77	Professional	52	$97.56	$124.52	$226.77
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $97.56 / $124.52 / $226.77	Professional	53	$97.56	$124.52	$226.77
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,673.72 / $2,178.87 / $2,500.00	Facility		$1,673.72	$2,178.87	$2,500.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $136.91 / $296.87 / $573.60	Professional		$136.91	$296.87	$573.60
United Facility/Professional Facility Modifier Low / Median / High Price $515.00 / $2,307.00 / $5,272.00	Facility		$515.00	$2,307.00	$5,272.00
United Facility/Professional Professional Modifier Low / Median / High Price $261.61 / $384.32 / $633.16	Professional		$261.61	$384.32	$633.16