Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $619.00 / $2,625.00 / $6,915.00	Facility		$619.00	$2,625.00	$6,915.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $75.87 / $164.54 / $882.01	Facility	52	$75.87	$164.54	$882.01
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $30.35 / $65.81 / $352.80	Facility	53	$30.35	$65.81	$352.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $149.63 / $416.49 / $2,248.44	Professional		$149.63	$416.49	$2,248.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $148.43 / $214.08 / $450.00	Professional		$148.43	$214.08	$450.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $568.00 / $2,081.07 / $4,819.75	Facility		$568.00	$2,081.07	$4,819.75
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.45 / $383.57 / $2,154.81	Professional		$194.45	$383.57	$2,154.81
CareSource Facility/Professional Facility Modifier Low / Median / High Price $148.43 / $199.81 / $237.49	Facility		$148.43	$199.81	$237.49
CareSource Facility/Professional Professional Modifier Low / Median / High Price $887.90 / $1,144.27 / $1,449.63	Professional		$887.90	$1,144.27	$1,449.63
Cigna Facility/Professional Facility Modifier Low / Median / High Price $448.00 / $715.00 / $1,091.58	Facility		$448.00	$715.00	$1,091.58
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $206.22 / $206.22 / $206.22	Facility	52	$206.22	$206.22	$206.22
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $51.55 / $51.55 / $51.55	Facility	53	$51.55	$51.55	$51.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.19 / $355.53 / $2,263.85	Professional		$186.19	$355.53	$2,263.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $170.69 / $559.05 / $1,484.73	Professional		$170.69	$559.05	$1,484.73
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $417.00 / $532.28 / $2,780.74	Professional	22	$417.00	$532.28	$2,780.74
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $121.63 / $155.25 / $811.05	Professional	52	$121.63	$155.25	$811.05
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $121.63 / $155.25 / $811.05	Professional	53	$121.63	$155.25	$811.05
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $156.29 / $668.64 / $1,904.27	Professional		$156.29	$668.64	$1,904.27
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 $211.06 / $1,139.05 / $2,251.42	Professional		$211.06	$1,139.05	$2,251.42