Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.90 / $95.50 / $426.58	Facility		$30.90	$95.50	$426.58
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $95.50 / $257.04 / $741.31	Facility	25	$95.50	$257.04	$741.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $51.29 / $112.20	Professional		$28.84	$51.29	$112.20
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $32.36 / $56.23 / $114.82	Professional	25	$32.36	$56.23	$114.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $54.95 / $83.18	Professional		$31.62	$54.95	$83.18
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $41.69 / $56.23 / $81.28	Professional	25	$41.69	$56.23	$81.28
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $43.65 / $79.43	Professional		$26.30	$43.65	$79.43
Anthem BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $34.67 / $34.67 / $34.67	Professional	25	$34.67	$34.67	$34.67
CareSource Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $47.86 / $67.61	Facility		$35.48	$47.86	$67.61
CareSource Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $61.66 / $83.18	Professional		$51.29	$61.66	$83.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $144.54 / $251.19	Facility		$100.00	$144.54	$251.19
Cigna Facility/Professional Facility Modifier 22 Low / Median / High Price $64.57 / $64.57 / $64.57	Facility	22	$64.57	$64.57	$64.57
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $33.88 / $33.88 / $33.88	Facility	62	$33.88	$33.88	$33.88
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $5.37 / $5.37 / $5.37	Facility	AS	$5.37	$5.37	$5.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $46.77 / $83.18	Professional		$28.84	$46.77	$83.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $60.26 / $102.33	Professional		$31.62	$60.26	$102.33
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $91.20 / $114.82 / $186.21	Professional	22	$91.20	$114.82	$186.21
Kaiser Permanente Facility/Professional Professional Modifier 62 Low / Median / High Price $28.18 / $36.31 / $57.54	Professional	62	$28.18	$36.31	$57.54
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $2.40 / $3.09 / $4.90	Professional	80	$2.40	$3.09	$4.90
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $1.20 / $1.51 / $2.45	Professional	AS	$1.20	$1.51	$2.45
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $549.54 / $549.54	Facility		$120.23	$549.54	$549.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $63.10 / $109.65	Professional		$36.31	$63.10	$109.65
United Facility/Professional Facility Modifier Low / Median / High Price $25.12 / $39.81 / $48.98	Facility		$25.12	$39.81	$48.98
United Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $41.69 / $69.18	Professional		$24.55	$41.69	$69.18