Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $83.40 / $2,297.00 / $6,726.00	Facility		$83.40	$2,297.00	$6,726.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $25.96 / $57.06 / $90.48	Facility	52	$25.96	$57.06	$90.48
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $10.38 / $22.82 / $36.19	Facility	53	$10.38	$22.82	$36.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.22 / $113.07 / $289.56	Professional		$69.22	$113.07	$289.56
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $27.13 / $48.60 / $119.64	Professional	52	$27.13	$48.60	$119.64
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $10.85 / $21.46 / $57.91	Professional	53	$10.85	$21.46	$57.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.96 / $171.03 / $187.26	Professional		$93.96	$171.03	$187.26
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $28.71 / $28.71 / $42.76	Professional	52	$28.71	$28.71	$42.76
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $734.14 / $2,080.80 / $3,851.83	Facility		$734.14	$2,080.80	$3,851.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $80.48 / $137.07 / $248.98	Professional		$80.48	$137.07	$248.98
CareSource Facility/Professional Facility Modifier Low / Median / High Price $61.92 / $84.18 / $93.20	Facility		$61.92	$84.18	$93.20
CareSource Facility/Professional Professional Modifier Low / Median / High Price $120.86 / $122.08 / $214.19	Professional		$120.86	$122.08	$214.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $65.37 / $65.37 / $65.37	Facility		$65.37	$65.37	$65.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.48 / $149.94 / $252.46	Professional		$95.48	$149.94	$252.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $68.11 / $107.84 / $167.19	Professional		$68.11	$107.84	$167.19
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $54.61 / $54.61 / $86.47	Professional	52	$54.61	$54.61	$86.47
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $54.61 / $54.61 / $86.47	Professional	53	$54.61	$54.61	$86.47
United Facility/Professional Facility Modifier Low / Median / High Price $212.00 / $1,550.00 / $2,665.00	Facility		$212.00	$1,550.00	$2,665.00
United Facility/Professional Professional Modifier Low / Median / High Price $100.92 / $149.80 / $233.55	Professional		$100.92	$149.80	$233.55