Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $496.77 / $2,497.50 / $6,510.25	Facility		$496.77	$2,497.50	$6,510.25
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $125.44 / $237.40 / $474.20	Facility	52	$125.44	$237.40	$474.20
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $50.17 / $94.96 / $189.68	Facility	53	$50.17	$94.96	$189.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.87 / $474.80 / $983.00	Professional		$250.87	$474.80	$983.00
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $50.17 / $93.24 / $185.64	Professional	53	$50.17	$93.24	$185.64
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $245.01 / $354.27 / $438.49	Professional		$245.01	$354.27	$438.49
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 $270.30 / $446.69 / $798.02	Professional		$270.30	$446.69	$798.02
CareSource Facility/Professional Facility Modifier Low / Median / High Price $245.01 / $330.65 / $392.02	Facility		$245.01	$330.65	$392.02
CareSource Facility/Professional Professional Modifier Low / Median / High Price $406.12 / $506.30 / $659.88	Professional		$406.12	$506.30	$659.88
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 $341.33 / $341.33 / $341.33	Facility	52	$341.33	$341.33	$341.33
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $85.33 / $85.33 / $85.33	Facility	53	$85.33	$85.33	$85.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $316.64 / $566.13 / $1,000.49	Professional		$316.64	$566.13	$1,000.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $281.76 / $502.42 / $1,199.65	Professional		$281.76	$502.42	$1,199.65
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $688.31 / $878.60 / $1,227.36	Professional	22	$688.31	$878.60	$1,227.36
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $200.76 / $256.26 / $357.98	Professional	52	$200.76	$256.26	$357.98
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $200.76 / $256.26 / $357.98	Professional	53	$200.76	$256.26	$357.98
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 $308.73 / $482.19 / $936.73	Professional		$308.73	$482.19	$936.73
United Facility/Professional Facility Modifier Low / Median / High Price $538.00 / $2,592.00 / $5,272.00	Facility		$538.00	$2,592.00	$5,272.00
United Facility/Professional Professional Modifier Low / Median / High Price $428.90 / $665.38 / $1,124.15	Professional		$428.90	$665.38	$1,124.15