Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $331.25 / $3,459.02 / $5,725.00	Facility		$331.25	$3,459.02	$5,725.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $82.39 / $156.40 / $1,238.00	Facility	52	$82.39	$156.40	$1,238.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $32.95 / $89.48 / $2,783.00	Facility	53	$32.95	$89.48	$2,783.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.24 / $312.79 / $583.25	Professional		$165.24	$312.79	$583.25
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $35.86 / $90.75 / $203.23	Professional	53	$35.86	$90.75	$203.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $179.23 / $315.44 / $332.76	Professional		$179.23	$315.44	$332.76
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $145.22 / $158.91 / $248.03	Professional	53	$145.22	$158.91	$248.03
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 $214.58 / $367.45 / $693.53	Professional		$214.58	$367.45	$693.53
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $91.21 / $169.77 / $352.34	Professional	53	$91.21	$169.77	$352.34
CareSource Facility/Professional Facility Modifier Low / Median / High Price $27.55 / $172.59 / $267.51	Facility		$27.55	$172.59	$267.51
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.96 / $168.71 / $436.64	Professional		$39.96	$168.71	$436.64
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 $194.94 / $194.94 / $194.94	Facility	52	$194.94	$194.94	$194.94
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $48.74 / $48.74 / $48.74	Facility	53	$48.74	$48.74	$48.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.75 / $301.75 / $697.88	Professional		$301.75	$301.75	$697.88
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $41.90 / $468.11 / $918.43	Professional	53	$41.90	$468.11	$918.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $179.23 / $329.19 / $870.67	Professional		$179.23	$329.19	$870.67
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $376.16 / $420.59 / $690.90	Professional	22	$376.16	$420.59	$690.90
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $109.71 / $122.67 / $201.51	Professional	52	$109.71	$122.67	$201.51
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $89.62 / $152.69 / $201.51	Professional	53	$89.62	$152.69	$201.51
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $955.38 / $1,625.05 / $2,150.00	Facility		$955.38	$1,625.05	$2,150.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $125.34 / $269.66 / $589.51	Professional		$125.34	$269.66	$589.51
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 $323.10 / $516.96 / $834.75	Professional		$323.10	$516.96	$834.75
United Facility/Professional Professional Modifier 53 Low / Median / High Price $88.55 / $88.55 / $88.55	Professional	53	$88.55	$88.55	$88.55