Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $106.70 / $106.70 / $106.70	Facility		$106.70	$106.70	$106.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $106.70 / $106.70 / $139.15	Professional		$106.70	$106.70	$139.15
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $106.70 / $106.70 / $108.83	Professional		$106.70	$106.70	$108.83
CareSource Facility/Professional Facility Modifier Low / Median / High Price $106.70 / $106.70 / $209.13	Facility		$106.70	$106.70	$209.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $100.66 / $100.66 / $106.70	Facility		$100.66	$100.66	$106.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.70 / $106.70 / $135.88	Professional		$106.70	$106.70	$135.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $136.85 / $136.85 / $341.00	Professional		$136.85	$136.85	$341.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $181.39 / $192.97 / $239.19	Professional		$181.39	$192.97	$239.19
United Facility/Professional Facility Modifier Low / Median / High Price $94.53 / $103.13 / $103.13	Facility		$94.53	$103.13	$103.13
United Facility/Professional Professional Modifier Low / Median / High Price $106.70 / $106.70 / $176.06	Professional		$106.70	$106.70	$176.06