Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.56 / $1,298.00 / $5,063.00	Facility		$53.56	$1,298.00	$5,063.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $81.77 / $635.65 / $3,299.20	Facility	50	$81.77	$635.65	$3,299.20
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $15.42 / $24.44 / $43.35	Facility	52	$15.42	$24.44	$43.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.04 / $48.11 / $105.00	Professional		$33.04	$48.11	$105.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $53.08 / $92.58 / $163.86	Professional	50	$53.08	$92.58	$163.86
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.42 / $23.09 / $54.54	Professional	52	$15.42	$23.09	$54.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $42.99 / $69.42 / $86.89	Professional		$42.99	$69.42	$86.89
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $89.08 / $122.51 / $130.33	Professional	50	$89.08	$122.51	$130.33
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $759.49 / $2,152.57 / $4,143.39	Facility		$759.49	$2,152.57	$4,143.39
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.18 / $62.06 / $106.68	Professional		$37.18	$62.06	$106.68
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $55.77 / $93.12 / $160.02	Professional	50	$55.77	$93.12	$160.02
CareSource Facility/Professional Facility Modifier Low / Median / High Price $31.32 / $42.39 / $46.93	Facility		$31.32	$42.39	$46.93
CareSource Facility/Professional Professional Modifier Low / Median / High Price $57.81 / $58.54 / $101.89	Professional		$57.81	$58.54	$101.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.61 / $66.48 / $118.49	Professional		$39.61	$66.48	$118.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $31.32 / $52.93 / $71.78	Professional		$31.32	$52.93	$71.78
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $81.77 / $81.77 / $122.18	Professional	22	$81.77	$81.77	$122.18
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $23.85 / $23.85 / $35.64	Professional	52	$23.85	$23.85	$35.64
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,185.00 / $1,185.00 / $1,185.00	Facility		$1,185.00	$1,185.00	$1,185.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $45.83 / $57.94 / $86.58	Professional		$45.83	$57.94	$86.58
United Facility/Professional Facility Modifier Low / Median / High Price $212.00 / $1,550.00 / $2,665.00	Facility		$212.00	$1,550.00	$2,665.00
United Facility/Professional Professional Modifier Low / Median / High Price $49.02 / $70.09 / $116.85	Professional		$49.02	$70.09	$116.85