Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,492.91 / $4,852.00 / $10,139.00	Facility		$1,492.91	$4,852.00	$10,139.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $628.05 / $950.22 / $1,251.64	Facility	54	$628.05	$950.22	$1,251.64
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $125.61 / $190.04 / $250.33	Facility	55	$125.61	$190.04	$250.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $715.02 / $926.03 / $1,915.16	Professional		$715.02	$926.03	$1,915.16
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $536.27 / $680.73 / $1,436.37	Professional	54	$536.27	$680.73	$1,436.37
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $107.25 / $136.15 / $291.85	Professional	55	$107.25	$136.15	$291.85
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $675.91 / $1,013.87 / $1,330.68	Professional		$675.91	$1,013.87	$1,330.68
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,136.19 / $3,106.53 / $5,292.58	Facility		$1,136.19	$3,106.53	$5,292.58
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $726.20 / $1,077.92 / $1,900.99	Professional		$726.20	$1,077.92	$1,900.99
CareSource Facility/Professional Facility Modifier Low / Median / High Price $716.73 / $980.07 / $2,850.37	Facility		$716.73	$980.07	$2,850.37
CareSource Facility/Professional Professional Modifier Low / Median / High Price $935.69 / $935.69 / $935.69	Professional		$935.69	$935.69	$935.69
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,227.11 / $1,347.00 / $1,668.88	Facility		$1,227.11	$1,347.00	$1,668.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $764.59 / $1,301.13 / $2,060.40	Professional		$764.59	$1,301.13	$2,060.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $788.40 / $1,553.00 / $5,802.07	Professional		$788.40	$1,553.00	$5,802.07
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $1,895.10 / $1,895.10 / $1,895.10	Professional	22	$1,895.10	$1,895.10	$1,895.10
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $884.38 / $884.38 / $884.38	Professional	54	$884.38	$884.38	$884.38
Kaiser Permanente Facility/Professional Professional Modifier 55 Low / Median / High Price $63.17 / $63.17 / $63.17	Professional	55	$63.17	$63.17	$63.17
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $2,363.12 / $2,363.12 / $3,250.00	Facility		$2,363.12	$2,363.12	$3,250.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $865.42 / $1,064.46 / $1,433.46	Professional		$865.42	$1,064.46	$1,433.46
United Facility/Professional Facility Modifier Low / Median / High Price $1,180.00 / $4,581.00 / $7,647.00	Facility		$1,180.00	$4,581.00	$7,647.00
United Facility/Professional Professional Modifier Low / Median / High Price $760.18 / $1,111.33 / $1,713.90	Professional		$760.18	$1,111.33	$1,713.90