Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $279.45 / $2,950.00 / $6,915.00	Facility		$279.45	$2,950.00	$6,915.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,250.31 / $1,250.31 / $1,250.31	Facility	50	$1,250.31	$1,250.31	$1,250.31
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $173.03 / $296.70 / $440.93	Facility	54	$173.03	$296.70	$440.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $210.83 / $289.20 / $584.07	Professional		$210.83	$289.20	$584.07
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $635.69 / $741.12 / $805.89	Professional	50	$635.69	$741.12	$805.89
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $153.53 / $214.88 / $470.88	Professional	54	$153.53	$214.88	$470.88
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $30.64 / $39.42 / $86.98	Professional	55	$30.64	$39.42	$86.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $220.80 / $322.94 / $437.64	Professional		$220.80	$322.94	$437.64
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $234.44 / $322.32 / $656.46	Professional	50	$234.44	$322.32	$656.46
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $837.59 / $2,485.30 / $4,184.53	Facility		$837.59	$2,485.30	$4,184.53
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $200.14 / $308.98 / $535.37	Professional		$200.14	$308.98	$535.37
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $300.20 / $463.48 / $803.05	Professional	50	$300.20	$463.48	$803.05
CareSource Facility/Professional Facility Modifier Low / Median / High Price $197.66 / $271.30 / $746.90	Facility		$197.66	$271.30	$746.90
CareSource Facility/Professional Professional Modifier Low / Median / High Price $305.82 / $305.82 / $305.82	Professional		$305.82	$305.82	$305.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $132.06 / $165.07 / $411.00	Facility		$132.06	$165.07	$411.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $237.44 / $390.32 / $629.90	Professional		$237.44	$390.32	$629.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $227.31 / $330.01 / $1,598.48	Professional		$227.31	$330.01	$1,598.48
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $243.90 / $243.90 / $290.86	Professional	54	$243.90	$243.90	$290.86
Kaiser Permanente Facility/Professional Professional Modifier 55 Low / Median / High Price $17.42 / $17.42 / $20.78	Professional	55	$17.42	$17.42	$20.78
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $660.00 / $660.00 / $660.00	Facility		$660.00	$660.00	$660.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $243.85 / $329.88 / $461.59	Professional		$243.85	$329.88	$461.59
United Facility/Professional Facility Modifier Low / Median / High Price $410.00 / $2,300.00 / $4,066.00	Facility		$410.00	$2,300.00	$4,066.00
United Facility/Professional Professional Modifier Low / Median / High Price $248.61 / $366.70 / $584.23	Professional		$248.61	$366.70	$584.23