Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $434.66 / $2,783.00 / $6,726.00	Facility		$434.66	$2,783.00	$6,726.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $99.27 / $227.08 / $407.28	Facility	52	$99.27	$227.08	$407.28
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $39.71 / $90.83 / $162.91	Facility	53	$39.71	$90.83	$162.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $195.38 / $437.72 / $884.12	Professional		$195.38	$437.72	$884.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $126.48 / $140.54 / $274.49	Professional		$126.48	$140.54	$274.49
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 / $361.41 / $610.11	Professional		$213.99	$361.41	$610.11
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 $390.46 / $490.16 / $634.86	Professional		$390.46	$490.16	$634.86
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 $260.00 / $465.97 / $933.96	Professional		$260.00	$465.97	$933.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $223.72 / $487.42 / $724.14	Professional		$223.72	$487.42	$724.14
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $546.54 / $697.64 / $1,190.71	Professional	22	$546.54	$697.64	$1,190.71
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $159.41 / $203.48 / $347.29	Professional	52	$159.41	$203.48	$347.29
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $159.41 / $203.48 / $347.29	Professional	53	$159.41	$203.48	$347.29
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $2,178.87 / $5,000.00 / $5,000.00	Facility		$2,178.87	$5,000.00	$5,000.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $245.32 / $451.23 / $877.88	Professional		$245.32	$451.23	$877.88
United Facility/Professional Facility Modifier Low / Median / High Price $550.00 / $2,496.00 / $5,272.00	Facility		$550.00	$2,496.00	$5,272.00
United Facility/Professional Professional Modifier Low / Median / High Price $394.94 / $582.94 / $998.45	Professional		$394.94	$582.94	$998.45