Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $33.33 / $78.29 / $300.67	Facility		$33.33	$78.29	$300.67
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $92.30 / $272.47 / $740.41	Facility	25	$92.30	$272.47	$740.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.29 / $45.23 / $92.00	Professional		$28.29	$45.23	$92.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $31.00 / $55.00 / $95.00	Professional	25	$31.00	$55.00	$95.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $39.27 / $63.09 / $97.53	Professional		$39.27	$63.09	$97.53
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $50.00 / $67.08 / $101.59	Professional	25	$50.00	$67.08	$101.59
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.30 / $50.23 / $96.68	Professional		$29.30	$50.23	$96.68
Anthem BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $34.95 / $34.95 / $34.95	Professional	25	$34.95	$34.95	$34.95
CareSource Facility/Professional Facility Modifier Low / Median / High Price $34.82 / $47.31 / $66.06	Facility		$34.82	$47.31	$66.06
CareSource Facility/Professional Professional Modifier Low / Median / High Price $51.60 / $64.70 / $84.11	Professional		$51.60	$64.70	$84.11
Cigna Facility/Professional Facility Modifier Low / Median / High Price $85.00 / $144.00 / $265.00	Facility		$85.00	$144.00	$265.00
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $29.37 / $29.37 / $29.37	Facility	62	$29.37	$29.37	$29.37
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $4.70 / $4.70 / $4.70	Facility	AS	$4.70	$4.70	$4.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.60 / $45.82 / $91.37	Professional		$26.60	$45.82	$91.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $37.54 / $63.37 / $121.40	Professional		$37.54	$63.37	$121.40
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $90.26 / $115.09 / $145.68	Professional	22	$90.26	$115.09	$145.68
Kaiser Permanente Facility/Professional Professional Modifier 62 Low / Median / High Price $28.21 / $35.97 / $45.53	Professional	62	$28.21	$35.97	$45.53
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $2.41 / $3.07 / $3.88	Professional	80	$2.41	$3.07	$3.88
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $1.20 / $1.53 / $1.94	Professional	AS	$1.20	$1.53	$1.94
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $120.14 / $120.14 / $124.06	Facility		$120.14	$120.14	$124.06
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $32.43 / $56.15 / $98.33	Professional		$32.43	$56.15	$98.33
United Facility/Professional Professional Modifier Low / Median / High Price $39.21 / $51.44 / $95.39	Professional		$39.21	$51.44	$95.39