Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $792.50 / $5,063.00 / $9,681.60	Facility		$792.50	$5,063.00	$9,681.60
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $93.71 / $234.56 / $596.41	Facility	52	$93.71	$234.56	$596.41
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $37.47 / $93.83 / $238.57	Facility	53	$37.47	$93.83	$238.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $219.56 / $624.33 / $3,153.54	Professional		$219.56	$624.33	$3,153.54
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $38.92 / $130.28 / $300.97	Professional	53	$38.92	$130.28	$300.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $203.82 / $409.56 / $2,356.17	Professional		$203.82	$409.56	$2,356.17
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $992.53 / $2,722.51 / $5,763.00	Facility		$992.53	$2,722.51	$5,763.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $279.92 / $626.70 / $2,460.19	Professional		$279.92	$626.70	$2,460.19
CareSource Facility/Professional Facility Modifier Low / Median / High Price $227.22 / $307.38 / $340.32	Facility		$227.22	$307.38	$340.32
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,448.90 / $1,452.75 / $2,480.87	Professional		$1,448.90	$1,452.75	$2,480.87
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,114.90 / $6,918.00 / $9,852.00	Facility		$2,114.90	$6,918.00	$9,852.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.93 / $610.91 / $3,030.25	Professional		$301.93	$610.91	$3,030.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $249.94 / $667.56 / $1,689.74	Professional		$249.94	$667.56	$1,689.74
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $687.17 / $687.17 / $3,650.08	Professional	22	$687.17	$687.17	$3,650.08
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $200.42 / $200.42 / $1,064.60	Professional	52	$200.42	$200.42	$1,064.60
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $200.42 / $200.42 / $1,064.60	Professional	53	$200.42	$200.42	$1,064.60
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $2,363.12 / $3,250.00 / $6,517.39	Facility		$2,363.12	$3,250.00	$6,517.39
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 $387.50 / $1,562.21 / $2,893.24	Professional		$387.50	$1,562.21	$2,893.24