Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $242.58 / $2,760.00 / $7,552.00	Facility		$242.58	$2,760.00	$7,552.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $40.75 / $121.14 / $181.08	Facility	52	$40.75	$121.14	$181.08
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $16.30 / $48.46 / $72.43	Facility	53	$16.30	$48.46	$72.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.17 / $233.40 / $484.50	Professional		$81.17	$233.40	$484.50
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $40.59 / $118.01 / $193.38	Professional	52	$40.59	$118.01	$193.38
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $16.23 / $47.20 / $77.34	Professional	53	$16.23	$47.20	$77.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $302.89 / $362.82 / $396.27	Professional		$302.89	$362.82	$396.27
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $36.20 / $36.20 / $36.20	Professional	52	$36.20	$36.20	$36.20
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $741.08 / $2,099.35 / $5,250.00	Facility		$741.08	$2,099.35	$5,250.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.61 / $235.69 / $446.75	Professional		$104.61	$235.69	$446.75
CareSource Facility/Professional Facility Modifier Low / Median / High Price $77.98 / $105.64 / $116.96	Facility		$77.98	$105.64	$116.96
CareSource Facility/Professional Professional Modifier Low / Median / High Price $259.10 / $260.87 / $448.24	Professional		$259.10	$260.87	$448.24
Cigna Facility/Professional Facility Modifier Low / Median / High Price $399.08 / $399.08 / $399.08	Facility		$399.08	$399.08	$399.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $119.95 / $243.50 / $506.66	Professional		$119.95	$243.50	$506.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $93.59 / $245.46 / $499.86	Professional		$93.59	$245.46	$499.86
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $192.02 / $192.02 / $525.53	Professional	22	$192.02	$192.02	$525.53
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $56.01 / $56.01 / $153.28	Professional	52	$56.01	$56.01	$153.28
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $56.01 / $56.01 / $153.28	Professional	53	$56.01	$56.01	$153.28
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,625.05 / $1,625.05 / $2,150.00	Facility		$1,625.05	$1,625.05	$2,150.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $117.59 / $129.46 / $364.88	Professional		$117.59	$129.46	$364.88
United Facility/Professional Facility Modifier Low / Median / High Price $796.00 / $2,300.00 / $3,593.00	Facility		$796.00	$2,300.00	$3,593.00
United Facility/Professional Professional Modifier Low / Median / High Price $208.89 / $303.33 / $488.84	Professional		$208.89	$303.33	$488.84