Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $370.25 / $2,607.00 / $6,519.00	Facility		$370.25	$2,607.00	$6,519.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $91.60 / $178.87 / $349.30	Facility	52	$91.60	$178.87	$349.30
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $69.59 / $123.62 / $2,095.69	Facility	53	$69.59	$123.62	$2,095.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.17 / $370.25 / $796.32	Professional		$180.17	$370.25	$796.32
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $42.37 / $108.03 / $234.43	Professional	53	$42.37	$108.03	$234.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $172.22 / $258.33 / $566.34	Professional		$172.22	$258.33	$566.34
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $64.83 / $112.37 / $166.69	Professional	53	$64.83	$112.37	$166.69
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $559.98 / $1,746.02 / $3,784.98	Facility		$559.98	$1,746.02	$3,784.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $196.75 / $321.50 / $601.32	Professional		$196.75	$321.50	$601.32
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $90.18 / $167.23 / $224.16	Professional	53	$90.18	$167.23	$224.16
CareSource Facility/Professional Facility Modifier Low / Median / High Price $27.55 / $172.22 / $266.94	Facility		$27.55	$172.22	$266.94
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.96 / $168.35 / $436.22	Professional		$39.96	$168.35	$436.22
Cigna Facility/Professional Facility Modifier Low / Median / High Price $453.00 / $618.29 / $2,880.00	Facility		$453.00	$618.29	$2,880.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $248.66 / $248.66 / $248.66	Facility	52	$248.66	$248.66	$248.66
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $62.17 / $62.17 / $62.17	Facility	53	$62.17	$62.17	$62.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $231.85 / $417.36 / $753.01	Professional		$231.85	$417.36	$753.01
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $116.81 / $215.03 / $539.57	Professional	53	$116.81	$215.03	$539.57
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $205.70 / $378.15 / $830.53	Professional		$205.70	$378.15	$830.53
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $502.50 / $641.41 / $923.78	Professional	22	$502.50	$641.41	$923.78
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $146.56 / $187.08 / $269.44	Professional	52	$146.56	$187.08	$269.44
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $102.85 / $164.42 / $277.86	Professional	53	$102.85	$164.42	$277.86
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $955.38 / $2,178.87 / $2,500.00	Facility		$955.38	$2,178.87	$2,500.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $128.96 / $269.99 / $588.69	Professional		$128.96	$269.99	$588.69
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 $303.13 / $495.75 / $807.75	Professional		$303.13	$495.75	$807.75
United Facility/Professional Professional Modifier 53 Low / Median / High Price $143.90 / $422.53 / $422.53	Professional	53	$143.90	$422.53	$422.53