Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $982.27 / $4,592.00 / $8,529.00	Facility		$982.27	$4,592.00	$8,529.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $5,927.47 / $8,529.00 / $10,152.48	Facility	50	$5,927.47	$8,529.00	$10,152.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $465.97 / $622.04 / $1,217.54	Professional		$465.97	$622.04	$1,217.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $551.08 / $811.05 / $957.07	Professional		$551.08	$811.05	$957.07
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $659.95 / $2,570.83 / $6,065.87	Facility		$659.95	$2,570.83	$6,065.87
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $525.86 / $791.28 / $1,398.80	Professional		$525.86	$791.28	$1,398.80
CareSource Facility/Professional Facility Modifier Low / Median / High Price $523.26 / $726.42 / $1,125.01	Facility		$523.26	$726.42	$1,125.01
CareSource Facility/Professional Professional Modifier Low / Median / High Price $490.71 / $607.71 / $800.68	Professional		$490.71	$607.71	$800.68
Cigna Facility/Professional Facility Modifier Low / Median / High Price $512.00 / $868.00 / $2,128.69	Facility		$512.00	$868.00	$2,128.69
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $58.98 / $58.98 / $58.98	Facility	AS	$58.98	$58.98	$58.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $503.28 / $810.46 / $1,253.32	Professional		$503.28	$810.46	$1,253.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $523.26 / $680.24 / $1,200.03	Professional		$523.26	$680.24	$1,200.03
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $1,470.02 / $1,470.02 / $1,876.45	Professional	22	$1,470.02	$1,470.02	$1,876.45
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $39.20 / $39.20 / $50.04	Professional	80	$39.20	$39.20	$50.04
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $19.60 / $19.60 / $25.02	Professional	AS	$19.60	$19.60	$25.02
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $3,725.00 / $3,725.00 / $4,233.47	Facility		$3,725.00	$3,725.00	$4,233.47
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $530.89 / $836.12 / $1,332.00	Professional		$530.89	$836.12	$1,332.00
United Facility/Professional Facility Modifier Low / Median / High Price $651.00 / $4,104.00 / $8,516.00	Facility		$651.00	$4,104.00	$8,516.00
United Facility/Professional Professional Modifier Low / Median / High Price $492.14 / $703.91 / $1,265.08	Professional		$492.14	$703.91	$1,265.08