Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,331.83 / $5,917.00 / $9,488.00	Facility		$1,331.83	$5,917.00	$9,488.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $761.36 / $863.90 / $1,185.03	Facility	54	$761.36	$863.90	$1,185.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $782.64 / $1,099.50 / $1,857.70	Professional		$782.64	$1,099.50	$1,857.70
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $129.97 / $164.93 / $267.02	Professional	55	$129.97	$164.93	$267.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $816.93 / $1,187.63 / $1,609.45	Professional		$816.93	$1,187.63	$1,609.45
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,078.00 / $3,107.04 / $5,240.56	Facility		$1,078.00	$3,107.04	$5,240.56
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $856.27 / $1,196.31 / $2,180.55	Professional		$856.27	$1,196.31	$2,180.55
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,505.72 / $1,826.03 / $74,999.25	Facility		$1,505.72	$1,826.03	$74,999.25
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,150.00 / $1,325.29 / $1,668.88	Facility		$1,150.00	$1,325.29	$1,668.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $859.22 / $1,286.17 / $2,310.77	Professional		$859.22	$1,286.17	$2,310.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $953.57 / $1,427.00 / $7,033.51	Professional		$953.57	$1,427.00	$7,033.51
Kaiser Permanente Facility/Professional Professional Modifier 54 Low / Median / High Price $1,069.64 / $1,069.64 / $1,069.64	Professional	54	$1,069.64	$1,069.64	$1,069.64
Kaiser Permanente Facility/Professional Professional Modifier 55 Low / Median / High Price $76.40 / $76.40 / $76.40	Professional	55	$76.40	$76.40	$76.40
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $1,125.45 / $1,291.65 / $1,547.07	Professional		$1,125.45	$1,291.65	$1,547.07
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 $856.26 / $1,130.80 / $1,999.18	Professional		$856.26	$1,130.80	$1,999.18