Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $695.75 / $3,937.50 / $9,698.45	Facility		$695.75	$3,937.50	$9,698.45
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $2,097.50 / $5,764.45 / $9,848.00	Facility	50	$2,097.50	$5,764.45	$9,848.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $78.69 / $218.73 / $375.17	Facility	52	$78.69	$218.73	$375.17
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $31.48 / $87.49 / $150.07	Facility	53	$31.48	$87.49	$150.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $157.38 / $450.53 / $978.73	Professional		$157.38	$450.53	$978.73
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $111.60 / $1,096.88 / $1,650.65	Professional	50	$111.60	$1,096.88	$1,650.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $218.91 / $255.40 / $802.13	Professional		$218.91	$255.40	$802.13
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $339.31 / $421.61 / $601.60	Professional	50	$339.31	$421.61	$601.60
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $996.37 / $3,116.30 / $7,089.10	Facility		$996.37	$3,116.30	$7,089.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $198.31 / $396.11 / $961.69	Professional		$198.31	$396.11	$961.69
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $297.45 / $594.16 / $1,442.54	Professional	50	$297.45	$594.16	$1,442.54
CareSource Facility/Professional Facility Modifier Low / Median / High Price $175.13 / $211.61 / $340.02	Facility		$175.13	$211.61	$340.02
CareSource Facility/Professional Professional Modifier Low / Median / High Price $441.78 / $445.00 / $766.26	Professional		$441.78	$445.00	$766.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,090.96 / $6,918.00 / $9,852.00	Facility		$2,090.96	$6,918.00	$9,852.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $193.07 / $477.00 / $948.14	Professional		$193.07	$477.00	$948.14
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $181.67 / $415.00 / $961.26	Professional		$181.67	$415.00	$961.26
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $372.78 / $372.78 / $894.49	Professional	22	$372.78	$372.78	$894.49
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $108.73 / $108.73 / $260.89	Professional	52	$108.73	$108.73	$260.89
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $108.73 / $108.73 / $260.89	Professional	53	$108.73	$108.73	$260.89
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $2,953.46 / $3,250.00 / $7,096.29	Facility		$2,953.46	$3,250.00	$7,096.29
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $229.18 / $251.31 / $630.38	Professional		$229.18	$251.31	$630.38
United Facility/Professional Facility Modifier Low / Median / High Price $1,200.00 / $4,826.00 / $7,889.00	Facility		$1,200.00	$4,826.00	$7,889.00
United Facility/Professional Professional Modifier Low / Median / High Price $453.15 / $640.28 / $981.87	Professional		$453.15	$640.28	$981.87