Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $323.59 / $3,467.37 / $6,456.54	Facility		$323.59	$3,467.37	$6,456.54
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $3,235.94 / $3,235.94 / $3,235.94	Facility	52	$3,235.94	$3,235.94	$3,235.94
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $81.28 / $112.20 / $162.18	Facility	53	$81.28	$112.20	$162.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $316.23 / $741.31	Professional		$165.96	$316.23	$741.31
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $74.13 / $128.82 / $234.42	Professional	53	$74.13	$128.82	$234.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $194.98 / $331.13	Professional		$165.96	$194.98	$331.13
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $144.54 / $144.54 / $165.96	Professional	53	$144.54	$144.54	$165.96
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $676.08 / $1,819.70 / $3,467.37	Facility		$676.08	$1,819.70	$3,467.37
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $380.19 / $707.95	Professional		$204.17	$380.19	$707.95
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $91.20 / $169.82 / $275.42	Professional	53	$91.20	$169.82	$275.42
CareSource Facility/Professional Facility Modifier Low / Median / High Price $33.88 / $186.21 / $295.12	Facility		$33.88	$186.21	$295.12
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $169.82 / $478.63	Professional		$39.81	$169.82	$478.63
Cigna Facility/Professional Facility Modifier Low / Median / High Price $512.86 / $645.65 / $2,691.53	Facility		$512.86	$645.65	$2,691.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $389.05	Professional		$302.00	$302.00	$389.05
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $41.69 / $151.36 / $912.01	Professional	53	$41.69	$151.36	$912.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $389.05 / $691.83	Professional		$169.82	$389.05	$691.83
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $371.54 / $416.87 / $776.25	Professional	22	$371.54	$416.87	$776.25
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $109.65 / $123.03 / $223.87	Professional	52	$109.65	$123.03	$223.87
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $85.11 / $190.55 / $288.40	Professional	53	$85.11	$190.55	$288.40
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $2,137.96 / $2,884.03 / $2,884.03	Facility		$2,137.96	$2,884.03	$2,884.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $239.88 / $707.95	Professional		$104.71	$239.88	$707.95
United Facility/Professional Facility Modifier Low / Median / High Price $398.11 / $1,548.82 / $3,162.28	Facility		$398.11	$1,548.82	$3,162.28
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $346.74 / $645.65	Professional		$190.55	$346.74	$645.65
United Facility/Professional Professional Modifier 53 Low / Median / High Price $204.17 / $204.17 / $204.17	Professional	53	$204.17	$204.17	$204.17