Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $394.89 / $2,625.00 / $6,519.00	Facility		$394.89	$2,625.00	$6,519.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $87.39 / $189.37 / $308.83	Facility	52	$87.39	$189.37	$308.83
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $34.96 / $75.75 / $123.53	Facility	53	$34.96	$75.75	$123.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $174.78 / $383.62 / $826.61	Professional		$174.78	$383.62	$826.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $162.97 / $287.49 / $686.36	Professional		$162.97	$287.49	$686.36
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 $225.27 / $388.46 / $755.76	Professional		$225.27	$388.46	$755.76
CareSource Facility/Professional Facility Modifier Low / Median / High Price $299.19 / $299.19 / $299.19	Facility		$299.19	$299.19	$299.19
CareSource Facility/Professional Professional Modifier Low / Median / High Price $160.58 / $160.58 / $160.58	Professional		$160.58	$160.58	$160.58
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 $237.29 / $237.29 / $237.29	Facility	52	$237.29	$237.29	$237.29
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $59.32 / $59.32 / $59.32	Facility	53	$59.32	$59.32	$59.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $215.81 / $392.14 / $781.05	Professional		$215.81	$392.14	$781.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $196.26 / $404.12 / $654.80	Professional		$196.26	$404.12	$654.80
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $479.45 / $612.00 / $1,032.10	Professional	22	$479.45	$612.00	$1,032.10
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $139.84 / $178.50 / $301.02	Professional	52	$139.84	$178.50	$301.02
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $139.84 / $178.50 / $301.02	Professional	53	$139.84	$178.50	$301.02
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $252.09 / $409.40 / $802.99	Professional		$252.09	$409.40	$802.99
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 $242.56 / $418.99 / $806.42	Professional		$242.56	$418.99	$806.42