Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $98.00 / $124.10 / $210.00	Facility		$98.00	$124.10	$210.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.50 / $143.33 / $212.19	Professional		$109.50	$143.33	$212.19
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $146.00 / $146.00 / $146.00	Professional	25	$146.00	$146.00	$146.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $88.94 / $125.40 / $255.72	Professional		$88.94	$125.40	$255.72
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $30.26 / $30.26 / $30.26	Professional	52	$30.26	$30.26	$30.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $103.38 / $157.06 / $286.60	Professional		$103.38	$157.06	$286.60
CareSource Facility/Professional Facility Modifier Low / Median / High Price $107.51 / $167.47 / $229.34	Facility		$107.51	$167.47	$229.34
CareSource Facility/Professional Professional Modifier Low / Median / High Price $133.46 / $210.30 / $269.27	Professional		$133.46	$210.30	$269.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.00 / $139.44 / $237.27	Professional		$77.00	$139.44	$237.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $150.51 / $175.56 / $398.72	Professional		$150.51	$175.56	$398.72
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $78.06 / $91.07 / $162.79	Professional	52	$78.06	$91.07	$162.79
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $124.59 / $174.86 / $287.23	Professional		$124.59	$174.86	$287.23
United Facility/Professional Professional Modifier Low / Median / High Price $123.56 / $181.87 / $447.75	Professional		$123.56	$181.87	$447.75