Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,374.00 / $5,186.24 / $10,139.00	Facility		$1,374.00	$5,186.24	$10,139.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $2,897.99 / $2,897.99 / $4,353.00	Facility	50	$2,897.99	$2,897.99	$4,353.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $122.27 / $184.47 / $248.85	Facility	53	$122.27	$184.47	$248.85
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $458.51 / $691.75 / $933.20	Facility	54	$458.51	$691.75	$933.20
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $91.70 / $138.35 / $186.64	Facility	55	$91.70	$138.35	$186.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $521.67 / $665.32 / $1,420.19	Professional		$521.67	$665.32	$1,420.19
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,779.89 / $1,779.89 / $1,779.89	Professional	50	$1,779.89	$1,779.89	$1,779.89
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $260.83 / $330.93 / $732.19	Professional	52	$260.83	$330.93	$732.19
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $391.26 / $496.39 / $1,039.07	Professional	54	$391.26	$496.39	$1,039.07
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $78.25 / $99.28 / $219.66	Professional	55	$78.25	$99.28	$219.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $472.62 / $739.25 / $1,338.15	Professional		$472.62	$739.25	$1,338.15
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,136.19 / $3,112.35 / $5,240.56	Facility		$1,136.19	$3,112.35	$5,240.56
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $529.99 / $832.08 / $1,486.51	Professional		$529.99	$832.08	$1,486.51
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $794.98 / $1,248.11 / $2,229.76	Professional	50	$794.98	$1,248.11	$2,229.76
CareSource Facility/Professional Facility Modifier Low / Median / High Price $523.23 / $714.60 / $2,293.90	Facility		$523.23	$714.60	$2,293.90
CareSource Facility/Professional Professional Modifier Low / Median / High Price $682.44 / $682.44 / $682.44	Professional		$682.44	$682.44	$682.44
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 $556.71 / $971.14 / $1,552.85	Professional		$556.71	$971.14	$1,552.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $575.54 / $1,152.86 / $4,235.80	Professional		$575.54	$1,152.86	$4,235.80
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $1,383.44 / $1,383.44 / $1,383.44	Professional	22	$1,383.44	$1,383.44	$1,383.44
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $403.50 / $403.50 / $403.50	Professional	52	$403.50	$403.50	$403.50
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $403.50 / $403.50 / $403.50	Professional	53	$403.50	$403.50	$403.50
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $645.61 / $645.61 / $645.61	Professional	54	$645.61	$645.61	$645.61
Kaiser Permanente Facility/Professional Professional Modifier 55 Low / Median / High Price $46.11 / $46.11 / $46.11	Professional	55	$46.11	$46.11	$46.11
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $2,350.10 / $2,363.12 / $3,250.00	Facility		$2,350.10	$2,363.12	$3,250.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $631.74 / $779.61 / $1,046.46	Professional		$631.74	$779.61	$1,046.46
United Facility/Professional Facility Modifier Low / Median / High Price $1,214.00 / $4,500.00 / $6,995.00	Facility		$1,214.00	$4,500.00	$6,995.00
United Facility/Professional Professional Modifier Low / Median / High Price $541.86 / $824.89 / $1,340.24	Professional		$541.86	$824.89	$1,340.24