Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $109.65 / $208.93	Facility		$97.72	$109.65	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $151.36 / $316.23	Professional		$109.65	$151.36	$316.23
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $144.54 / $144.54 / $676.08	Professional	25	$144.54	$144.54	$676.08
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $512.86 / $512.86 / $512.86	Professional	52	$512.86	$512.86	$512.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $128.82 / $181.97	Professional		$102.33	$128.82	$181.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $151.36 / $229.09	Professional		$112.20	$151.36	$229.09
CareSource Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $169.82 / $234.42	Facility		$109.65	$169.82	$234.42
CareSource Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $218.78 / $389.05	Professional		$134.90	$218.78	$389.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $141.25 / $234.42	Professional		$79.43	$141.25	$234.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $177.83 / $245.47	Professional		$141.25	$177.83	$245.47
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $77.62 / $91.20 / $162.18	Professional	52	$77.62	$91.20	$162.18
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $165.96 / $257.04	Professional		$107.15	$165.96	$257.04
United Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $75.86 / $75.86	Facility		$75.86	$75.86	$75.86
United Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $165.96 / $323.59	Professional		$114.82	$165.96	$323.59