Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $115.45 / $2,221.00 / $6,758.29	Facility		$115.45	$2,221.00	$6,758.29
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $367.70 / $367.70 / $367.70	Facility	50	$367.70	$367.70	$367.70
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $10.64 / $23.09 / $43.93	Facility	53	$10.64	$23.09	$43.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.19 / $105.13 / $296.89	Professional		$49.19	$105.13	$296.89
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $73.95 / $159.19 / $459.95	Professional	50	$73.95	$159.19	$459.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $66.56 / $98.09 / $226.79	Professional		$66.56	$98.09	$226.79
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $295.77 / $295.77 / $340.18	Professional	50	$295.77	$295.77	$340.18
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $450.00 / $839.59 / $1,697.15	Facility		$450.00	$839.59	$1,697.15
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.48 / $86.25 / $171.47	Professional		$50.48	$86.25	$171.47
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $75.72 / $129.38 / $257.20	Professional	50	$75.72	$129.38	$257.20
CareSource Facility/Professional Facility Modifier Low / Median / High Price $52.46 / $73.69 / $149.15	Facility		$52.46	$73.69	$149.15
CareSource Facility/Professional Professional Modifier Low / Median / High Price $99.21 / $126.26 / $135.97	Professional		$99.21	$126.26	$135.97
Cigna Facility/Professional Facility Modifier Low / Median / High Price $86.31 / $86.31 / $2,500.00	Facility		$86.31	$86.31	$2,500.00
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $17.26 / $17.26 / $17.26	Facility	53	$17.26	$17.26	$17.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.48 / $122.93 / $266.72	Professional		$67.48	$122.93	$266.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.80 / $127.52 / $399.95	Professional		$61.80	$127.52	$399.95
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $49.73 / $49.73 / $107.51	Professional	53	$49.73	$49.73	$107.51
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,625.05 / $1,625.05 / $3,025.00	Facility		$1,625.05	$1,625.05	$3,025.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.72 / $106.21 / $196.50	Professional		$60.72	$106.21	$196.50
United Facility/Professional Facility Modifier Low / Median / High Price $175.00 / $1,550.00 / $2,665.00	Facility		$175.00	$1,550.00	$2,665.00
United Facility/Professional Professional Modifier Low / Median / High Price $90.81 / $170.69 / $293.91	Professional		$90.81	$170.69	$293.91