Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $3,019.95 / $7,079.46	Facility		$295.12	$3,019.95	$7,079.46
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $645.65 / $3,162.28 / $6,456.54	Facility	50	$645.65	$3,162.28	$6,456.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $245.47 / $691.83	Professional		$107.15	$245.47	$691.83
Aetna Facility/Professional Professional Modifier 22 Low / Median / High Price $478.63 / $478.63 / $1,548.82	Professional	22	$478.63	$478.63	$1,548.82
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $158.49 / $501.19 / $1,047.13	Professional	50	$158.49	$501.19	$1,047.13
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $51.29 / $97.72 / $138.04	Professional	53	$51.29	$97.72	$138.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $181.97 / $436.52	Professional		$104.71	$181.97	$436.52
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $154.88 / $288.40 / $741.31	Professional	50	$154.88	$288.40	$741.31
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $758.58 / $1,819.70 / $3,548.13	Facility		$758.58	$1,819.70	$3,548.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $186.21 / $346.74	Professional		$134.90	$186.21	$346.74
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $204.17 / $281.84 / $524.81	Professional	50	$204.17	$281.84	$524.81
CareSource Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $154.88 / $213.80	Facility		$128.82	$154.88	$213.80
CareSource Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $275.42 / $323.59	Professional		$213.80	$275.42	$323.59
Cigna Facility/Professional Facility Modifier Low / Median / High Price $186.21 / $660.69 / $758.58	Facility		$186.21	$660.69	$758.58
Cigna Facility/Professional Facility Modifier 22 Low / Median / High Price $223.87 / $223.87 / $223.87	Facility	22	$223.87	$223.87	$223.87
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $38.02 / $38.02 / $38.02	Facility	53	$38.02	$38.02	$38.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $257.04 / $537.03	Professional		$128.82	$257.04	$537.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $316.23 / $870.96	Professional		$117.49	$316.23	$870.96
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $371.54 / $371.54 / $812.83	Professional	22	$371.54	$371.54	$812.83
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $109.65 / $109.65 / $239.88	Professional	53	$109.65	$109.65	$239.88
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $3,235.94 / $3,715.35 / $3,715.35	Facility		$3,235.94	$3,715.35	$3,715.35
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $346.74 / $389.05	Professional		$158.49	$346.74	$389.05
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 $107.15 / $218.78 / $501.19	Professional		$107.15	$218.78	$501.19