Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $395.78 / $2,044.00 / $6,726.00	Facility		$395.78	$2,044.00	$6,726.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,851.00 / $1,851.00 / $1,851.00	Facility	50	$1,851.00	$1,851.00	$1,851.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $263.66 / $288.63 / $415.05	Facility	54	$263.66	$288.63	$415.05
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $52.73 / $56.83 / $83.01	Facility	55	$52.73	$56.83	$83.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.14 / $378.84 / $667.03	Professional		$269.14	$378.84	$667.03
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $465.29 / $670.00 / $1,055.00	Professional	50	$465.29	$670.00	$1,055.00
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $223.42 / $288.63 / $449.56	Professional	54	$223.42	$288.63	$449.56
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $44.68 / $57.70 / $84.85	Professional	55	$44.68	$57.70	$84.85
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $297.38 / $418.22 / $569.35	Professional		$297.38	$418.22	$569.35
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $504.53 / $504.53 / $854.02	Professional	50	$504.53	$504.53	$854.02
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $707.23 / $2,080.80 / $3,851.83	Facility		$707.23	$2,080.80	$3,851.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $288.30 / $405.23 / $755.63	Professional		$288.30	$405.23	$755.63
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $432.45 / $607.85 / $1,133.44	Professional	50	$432.45	$607.85	$1,133.44
CareSource Facility/Professional Facility Modifier Low / Median / High Price $299.38 / $404.27 / $1,117.13	Facility		$299.38	$404.27	$1,117.13
CareSource Facility/Professional Professional Modifier Low / Median / High Price $412.24 / $412.24 / $412.24	Professional		$412.24	$412.24	$412.24
Cigna Facility/Professional Facility Modifier Low / Median / High Price $297.63 / $372.03 / $551.00	Facility		$297.63	$372.03	$551.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $280.18 / $422.18 / $792.82	Professional		$280.18	$422.18	$792.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $344.29 / $448.48 / $2,435.63	Professional		$344.29	$448.48	$2,435.63
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $369.40 / $369.40 / $395.26	Professional	54	$369.40	$369.40	$395.26
Kaiser Permanente Facility/Professional Professional Modifier 55 Low / Median / High Price $26.39 / $26.39 / $28.23	Professional	55	$26.39	$26.39	$28.23
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $800.00 / $800.00 / $800.00	Facility		$800.00	$800.00	$800.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $279.73 / $463.35 / $825.27	Professional		$279.73	$463.35	$825.27
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 $295.14 / $402.23 / $722.52	Professional		$295.14	$402.23	$722.52