Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $442.00 / $2,862.50 / $8,574.64	Facility		$442.00	$2,862.50	$8,574.64
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $68.26 / $195.73 / $378.37	Facility	52	$68.26	$195.73	$378.37
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $27.30 / $78.29 / $2,260.02	Facility	53	$27.30	$78.29	$2,260.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.13 / $308.00 / $813.76	Professional		$72.13	$308.00	$813.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $96.32 / $183.64 / $357.49	Professional		$96.32	$183.64	$357.49
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $542.00 / $1,729.39 / $3,784.98	Facility		$542.00	$1,729.39	$3,784.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $180.04 / $385.48 / $798.70	Professional		$180.04	$385.48	$798.70
CareSource Facility/Professional Facility Modifier Low / Median / High Price $133.68 / $179.79 / $214.07	Facility		$133.68	$179.79	$214.07
CareSource Facility/Professional Professional Modifier Low / Median / High Price $326.64 / $413.98 / $532.01	Professional		$326.64	$413.98	$532.01
Cigna Facility/Professional Facility Modifier Low / Median / High Price $448.00 / $610.44 / $770.87	Facility		$448.00	$610.44	$770.87
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $185.70 / $185.70 / $185.70	Facility	52	$185.70	$185.70	$185.70
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $46.42 / $46.42 / $46.42	Facility	53	$46.42	$46.42	$46.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.53 / $372.48 / $748.05	Professional		$181.53	$372.48	$748.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $153.72 / $393.24 / $692.10	Professional		$153.72	$393.24	$692.10
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $375.56 / $479.39 / $1,004.32	Professional	22	$375.56	$479.39	$1,004.32
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $109.54 / $139.82 / $292.93	Professional	52	$109.54	$139.82	$292.93
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $109.54 / $139.82 / $292.93	Professional	53	$109.54	$139.82	$292.93
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $153.72 / $375.84 / $716.55	Professional		$153.72	$375.84	$716.55
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 $306.89 / $456.51 / $795.70	Professional		$306.89	$456.51	$795.70