Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.19 / $99.91 / $445.40	Facility		$54.19	$99.91	$445.40
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $255.00 / $361.17 / $579.13	Facility	25	$255.00	$361.17	$579.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.29 / $78.39 / $154.00	Professional		$52.29	$78.39	$154.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $55.43 / $85.71 / $172.27	Professional	25	$55.43	$85.71	$172.27
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $254.64 / $262.68 / $271.76	Professional	50	$254.64	$262.68	$271.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $68.48 / $113.42 / $160.91	Professional		$68.48	$113.42	$160.91
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $84.25 / $116.01 / $165.68	Professional	25	$84.25	$116.01	$165.68
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $199.00 / $199.00 / $199.00	Professional	50	$199.00	$199.00	$199.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $55.45 / $85.19 / $164.28	Professional		$55.45	$85.19	$164.28
Anthem BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $48.96 / $48.96 / $48.96	Professional	25	$48.96	$48.96	$48.96
CareSource Facility/Professional Facility Modifier Low / Median / High Price $65.36 / $88.70 / $123.94	Facility		$65.36	$88.70	$123.94
CareSource Facility/Professional Professional Modifier Low / Median / High Price $83.88 / $104.85 / $137.19	Professional		$83.88	$104.85	$137.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $88.08 / $144.00 / $265.00	Facility		$88.08	$144.00	$265.00
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $55.05 / $55.05 / $55.05	Facility	62	$55.05	$55.05	$55.05
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $8.81 / $8.81 / $8.81	Facility	AS	$8.81	$8.81	$8.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.70 / $79.93 / $146.78	Professional		$50.70	$79.93	$146.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.08 / $97.55 / $196.64	Professional		$64.08	$97.55	$196.64
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $169.45 / $216.04 / $235.97	Professional	22	$169.45	$216.04	$235.97
Kaiser Permanente Facility/Professional Professional Modifier 62 Low / Median / High Price $52.95 / $67.51 / $73.73	Professional	62	$52.95	$67.51	$73.73
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $4.51 / $5.76 / $6.29	Professional	80	$4.51	$5.76	$6.29
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $2.25 / $2.88 / $3.15	Professional	AS	$2.25	$2.88	$3.15
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $145.22 / $145.22 / $149.94	Facility		$145.22	$145.22	$149.94
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $59.62 / $96.71 / $158.78	Professional		$59.62	$96.71	$158.78
United Facility/Professional Professional Modifier Low / Median / High Price $63.13 / $83.67 / $152.12	Professional		$63.13	$83.67	$152.12