Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $317.27 / $3,043.00 / $6,209.00	Facility		$317.27	$3,043.00	$6,209.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $82.25 / $156.26 / $291.63	Facility	52	$82.25	$156.26	$291.63
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $32.90 / $81.96 / $163.02	Facility	53	$32.90	$81.96	$163.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $164.95 / $312.51 / $571.89	Professional		$164.95	$312.51	$571.89
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $35.79 / $90.43 / $209.20	Professional	53	$35.79	$90.43	$209.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $178.87 / $316.60 / $495.47	Professional		$178.87	$316.60	$495.47
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $111.89 / $158.26 / $164.39	Professional	53	$111.89	$158.26	$164.39
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $542.00 / $1,729.39 / $3,784.98	Facility		$542.00	$1,729.39	$3,784.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $207.78 / $373.54 / $693.53	Professional		$207.78	$373.54	$693.53
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $90.87 / $169.43 / $331.74	Professional	53	$90.87	$169.43	$331.74
CareSource Facility/Professional Facility Modifier Low / Median / High Price $27.45 / $172.22 / $266.94	Facility		$27.45	$172.22	$266.94
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.90 / $168.35 / $436.22	Professional		$39.90	$168.35	$436.22
Cigna Facility/Professional Facility Modifier Low / Median / High Price $506.00 / $618.29 / $2,880.00	Facility		$506.00	$618.29	$2,880.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $194.61 / $194.61 / $194.61	Facility	52	$194.61	$194.61	$194.61
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $48.65 / $48.65 / $48.65	Facility	53	$48.65	$48.65	$48.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.45 / $301.45 / $697.11	Professional		$301.45	$301.45	$697.11
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $41.90 / $294.89 / $916.78	Professional	53	$41.90	$294.89	$916.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $178.87 / $328.83 / $869.22	Professional		$178.87	$328.83	$869.22
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $375.40 / $419.74 / $690.12	Professional	22	$375.40	$419.74	$690.12
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $109.49 / $122.42 / $201.29	Professional	52	$109.49	$122.42	$201.29
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $89.44 / $152.52 / $201.29	Professional	53	$89.44	$152.52	$201.29
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,625.05 / $2,150.00 / $2,150.00	Facility		$1,625.05	$2,150.00	$2,150.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $124.80 / $268.31 / $588.69	Professional		$124.80	$268.31	$588.69
United Facility/Professional Facility Modifier Low / Median / High Price $394.00 / $1,952.00 / $4,066.00	Facility		$394.00	$1,952.00	$4,066.00
United Facility/Professional Professional Modifier Low / Median / High Price $315.39 / $495.87 / $795.01	Professional		$315.39	$495.87	$795.01
United Facility/Professional Professional Modifier 53 Low / Median / High Price $88.55 / $88.55 / $88.55	Professional	53	$88.55	$88.55	$88.55