Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $724.82 / $3,911.00 / $6,915.00	Facility		$724.82	$3,911.00	$6,915.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $85.06 / $144.96 / $467.17	Facility	53	$85.06	$144.96	$467.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $383.36 / $952.56 / $3,704.95	Professional		$383.36	$952.56	$3,704.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $506.91 / $715.69 / $4,624.24	Professional		$506.91	$715.69	$4,624.24
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $996.37 / $5,625.09 / $35,850.44	Facility		$996.37	$5,625.09	$35,850.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $409.68 / $621.20 / $1,331.17	Professional		$409.68	$621.20	$1,331.17
CareSource Facility/Professional Facility Modifier Low / Median / High Price $430.74 / $565.40 / $779.86	Facility		$430.74	$565.40	$779.86
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,961.61 / $2,463.33 / $2,652.82	Professional		$1,961.61	$2,463.33	$2,652.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $705.51 / $6,918.00 / $10,047.00	Facility		$705.51	$6,918.00	$10,047.00
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $141.10 / $141.10 / $141.10	Facility	53	$141.10	$141.10	$141.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $471.41 / $990.02 / $4,337.62	Professional		$471.41	$990.02	$4,337.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $506.91 / $2,443.62 / $3,718.56	Professional		$506.91	$2,443.62	$3,718.56
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $411.60 / $411.60 / $2,150.79	Professional	53	$411.60	$411.60	$2,150.79
United Facility/Professional Facility Modifier Low / Median / High Price $3,293.00 / $9,576.00 / $40,000.00	Facility		$3,293.00	$9,576.00	$40,000.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,415.77 / $2,174.75 / $4,918.14	Professional		$1,415.77	$2,174.75	$4,918.14