Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $257.38 / $3,143.12 / $6,758.29	Facility		$257.38	$3,143.12	$6,758.29
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,648.83 / $3,159.11 / $6,468.00	Facility	50	$1,648.83	$3,159.11	$6,468.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $22.78 / $51.48 / $89.52	Facility	53	$22.78	$51.48	$89.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $105.68 / $242.95 / $654.13	Professional		$105.68	$242.95	$654.13
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $198.92 / $690.09 / $1,034.22	Professional	50	$198.92	$690.09	$1,034.22
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $20.98 / $47.56 / $93.10	Professional	53	$20.98	$47.56	$93.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $113.91 / $206.76 / $502.04	Professional		$113.91	$206.76	$502.04
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $170.86 / $325.42 / $753.06	Professional	50	$170.86	$325.42	$753.06
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $635.46 / $1,949.16 / $3,851.83	Facility		$635.46	$1,949.16	$3,851.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.34 / $177.21 / $335.36	Professional		$109.34	$177.21	$335.36
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $164.01 / $264.94 / $503.05	Professional	50	$164.01	$264.94	$503.05
CareSource Facility/Professional Facility Modifier Low / Median / High Price $114.65 / $160.50 / $328.64	Facility		$114.65	$160.50	$328.64
CareSource Facility/Professional Professional Modifier Low / Median / High Price $220.24 / $279.27 / $300.76	Professional		$220.24	$279.27	$300.76
Cigna Facility/Professional Facility Modifier Low / Median / High Price $188.07 / $188.07 / $750.00	Facility		$188.07	$188.07	$750.00
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $37.61 / $37.61 / $37.61	Facility	53	$37.61	$37.61	$37.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $126.85 / $262.75 / $525.13	Professional		$126.85	$262.75	$525.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $134.62 / $283.54 / $683.34	Professional		$134.62	$283.54	$683.34
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $375.68 / $375.68 / $820.01	Professional	22	$375.68	$375.68	$820.01
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $109.57 / $109.57 / $239.17	Professional	53	$109.57	$109.57	$239.17
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,625.05 / $1,625.05 / $3,225.00	Facility		$1,625.05	$1,625.05	$3,225.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $136.02 / $236.28 / $437.12	Professional		$136.02	$236.28	$437.12
United Facility/Professional Facility Modifier Low / Median / High Price $426.00 / $2,360.00 / $4,066.00	Facility		$426.00	$2,360.00	$4,066.00
United Facility/Professional Professional Modifier Low / Median / High Price $206.45 / $354.67 / $627.46	Professional		$206.45	$354.67	$627.46