Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $46.77 / $81.28	Facility		$30.20	$46.77	$81.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $52.48 / $114.82	Professional		$30.90	$52.48	$114.82
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $45.71 / $93.33 / $147.91	Professional	25	$45.71	$93.33	$147.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $48.98 / $83.18	Professional		$38.02	$48.98	$83.18
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $42.66 / $63.10 / $89.13	Professional	25	$42.66	$63.10	$89.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $45.71 / $79.43	Professional		$36.31	$45.71	$79.43
CareSource Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $66.07 / $97.72	Facility		$57.54	$66.07	$97.72
CareSource Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $58.88 / $112.20	Professional		$45.71	$58.88	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $52.48 / $97.72	Professional		$35.48	$52.48	$97.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $63.10 / $117.49	Professional		$44.67	$63.10	$117.49
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $125.89 / $125.89 / $125.89	Professional	22	$125.89	$125.89	$125.89
Kaiser Permanente Facility/Professional Professional Modifier 80 Low / Median / High Price $3.39 / $3.39 / $3.39	Professional	80	$3.39	$3.39	$3.39
Kaiser Permanente Facility/Professional Professional Modifier AS Low / Median / High Price $1.70 / $1.70 / $1.70	Professional	AS	$1.70	$1.70	$1.70
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $77.62 / $100.00	Professional		$45.71	$77.62	$100.00
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $46.77 / $97.72	Professional		$38.02	$46.77	$97.72