Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $4,278.22 / $8,680.59 / $15,557.00	Facility		$4,278.22	$8,680.59	$15,557.00
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $4,748.99 / $10,524.00 / $10,524.00	Facility	22	$4,748.99	$10,524.00	$10,524.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $329.71 / $565.16 / $648.35	Facility	52	$329.71	$565.16	$648.35
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $131.88 / $226.07 / $259.33	Facility	53	$131.88	$226.07	$259.33
Aetna Facility/Professional Facility Modifier 80 Low / Median / High Price $24,720.89 / $24,720.89 / $24,720.89	Facility	80	$24,720.89	$24,720.89	$24,720.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $641.16 / $780.71 / $1,563.71	Professional		$641.16	$780.71	$1,563.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $696.39 / $949.64 / $1,209.20	Professional		$696.39	$949.64	$1,209.20
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,267.00 / $4,405.96 / $12,251.17	Facility		$1,267.00	$4,405.96	$12,251.17
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $662.66 / $1,079.18 / $1,848.39	Professional		$662.66	$1,079.18	$1,848.39
CareSource Facility/Professional Facility Modifier Low / Median / High Price $659.04 / $886.33 / $1,054.46	Facility		$659.04	$886.33	$1,054.46
CareSource Facility/Professional Professional Modifier Low / Median / High Price $617.02 / $767.21 / $1,010.83	Professional		$617.02	$767.21	$1,010.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $753.07 / $3,271.75 / $9,353.00	Facility		$753.07	$3,271.75	$9,353.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $594.13 / $594.13 / $594.13	Facility	52	$594.13	$594.13	$594.13
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $148.53 / $148.53 / $148.53	Facility	53	$148.53	$148.53	$148.53
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $74.27 / $74.27 / $74.27	Facility	AS	$74.27	$74.27	$74.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $694.39 / $1,041.60 / $1,578.54	Professional		$694.39	$1,041.60	$1,578.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $659.04 / $856.75 / $1,626.14	Professional		$659.04	$856.75	$1,626.14
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $1,851.46 / $1,851.46 / $2,363.34	Professional	22	$1,851.46	$1,851.46	$2,363.34
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $540.01 / $540.01 / $689.31	Professional	52	$540.01	$540.01	$689.31
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $540.01 / $540.01 / $896.10	Professional	53	$540.01	$540.01	$896.10
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $49.37 / $49.37 / $63.02	Professional	80	$49.37	$49.37	$63.02
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $24.69 / $24.69 / $31.51	Professional	AS	$24.69	$24.69	$31.51
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $664.74 / $1,053.63 / $1,673.70	Professional		$664.74	$1,053.63	$1,673.70
United Facility/Professional Facility Modifier Low / Median / High Price $851.00 / $6,868.00 / $16,376.00	Facility		$851.00	$6,868.00	$16,376.00
United Facility/Professional Professional Modifier Low / Median / High Price $644.44 / $935.21 / $1,527.37	Professional		$644.44	$935.21	$1,527.37