Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $3,019.95 / $5,623.41	Facility		$630.96	$3,019.95	$5,623.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $229.09 / $588.84	Professional		$93.33	$229.09	$588.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $177.83 / $457.09	Professional		$93.33	$177.83	$457.09
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $794.33 / $2,089.30 / $3,548.13	Facility		$794.33	$2,089.30	$3,548.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $165.96 / $245.47	Professional		$109.65	$165.96	$245.47
CareSource Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $138.04 / $190.55	Facility		$114.82	$138.04	$190.55
CareSource Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $288.40 / $338.84	Professional		$223.87	$288.40	$338.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $169.82 / $1,148.15	Facility		$169.82	$169.82	$1,148.15
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $33.88 / $33.88 / $33.88	Facility	53	$33.88	$33.88	$33.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $251.19 / $562.34	Professional		$123.03	$251.19	$562.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $316.23 / $1,778.28	Professional		$104.71	$316.23	$1,778.28
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $97.72 / $97.72 / $251.19	Professional	53	$97.72	$97.72	$251.19
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $3,467.37	Facility		$1,949.84	$1,949.84	$3,467.37
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $251.19 / $549.54	Professional		$95.50	$251.19	$549.54
United Facility/Professional Facility Modifier Low / Median / High Price $426.58 / $2,187.76 / $3,467.37	Facility		$426.58	$2,187.76	$3,467.37
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $223.87 / $489.78	Professional		$100.00	$223.87	$489.78