Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $454.52 / $2,843.98 / $7,513.80	Facility		$454.52	$2,843.98	$7,513.80
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $99.27 / $245.33 / $2,234.00	Facility	52	$99.27	$245.33	$2,234.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $39.71 / $90.08 / $167.73	Facility	53	$39.71	$90.08	$167.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $195.37 / $450.39 / $987.28	Professional		$195.37	$450.39	$987.28
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $99.27 / $225.20 / $521.53	Professional	52	$99.27	$225.20	$521.53
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $39.71 / $90.08 / $201.31	Professional	53	$39.71	$90.08	$201.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $194.54 / $344.34 / $775.87	Professional		$194.54	$344.34	$775.87
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $33.49 / $43.49 / $60.90	Professional	52	$33.49	$43.49	$60.90
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $173.94 / $173.94 / $173.94	Professional	53	$173.94	$173.94	$173.94
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $568.00 / $2,111.58 / $4,819.75	Facility		$568.00	$2,111.58	$4,819.75
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $213.99 / $366.92 / $669.55	Professional		$213.99	$366.92	$669.55
CareSource Facility/Professional Facility Modifier Low / Median / High Price $194.54 / $262.33 / $311.26	Facility		$194.54	$262.33	$311.26
CareSource Facility/Professional Professional Modifier Low / Median / High Price $383.32 / $480.85 / $623.17	Professional		$383.32	$480.85	$623.17
Cigna Facility/Professional Facility Modifier Low / Median / High Price $453.00 / $716.39 / $2,880.00	Facility		$453.00	$716.39	$2,880.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $270.52 / $270.52 / $270.52	Facility	52	$270.52	$270.52	$270.52
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $67.63 / $67.63 / $67.63	Facility	53	$67.63	$67.63	$67.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $262.82 / $484.35 / $923.10	Professional		$262.82	$484.35	$923.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $223.72 / $478.15 / $938.19	Professional		$223.72	$478.15	$938.19
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $546.53 / $697.63 / $1,168.04	Professional	22	$546.53	$697.63	$1,168.04
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $159.40 / $203.48 / $340.68	Professional	52	$159.40	$203.48	$340.68
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $159.40 / $203.48 / $340.68	Professional	53	$159.40	$203.48	$340.68
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,229.11 / $2,178.87 / $2,500.00	Facility		$1,229.11	$2,178.87	$2,500.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $245.32 / $441.76 / $877.88	Professional		$245.32	$441.76	$877.88
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 $401.71 / $602.44 / $1,005.23	Professional		$401.71	$602.44	$1,005.23