Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $353.91 / $1,761.00 / $4,261.00	Facility		$353.91	$1,761.00	$4,261.00
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $1,477.00 / $1,477.00 / $1,477.00	Facility	22	$1,477.00	$1,477.00	$1,477.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $84.03 / $156.49 / $1,773.50	Facility	52	$84.03	$156.49	$1,773.50
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $95.40 / $173.94 / $265.18	Facility	53	$95.40	$173.94	$265.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $178.50 / $323.31 / $928.53	Professional		$178.50	$323.31	$928.53
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $38.81 / $98.10 / $215.99	Professional	53	$38.81	$98.10	$215.99
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $150.53 / $209.94 / $340.32	Professional		$150.53	$209.94	$340.32
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $65.41 / $101.59 / $139.81	Professional	53	$65.41	$101.59	$139.81
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $770.00 / $1,508.00 / $3,523.00	Facility		$770.00	$1,508.00	$3,523.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $200.09 / $308.68 / $447.38	Professional		$200.09	$308.68	$447.38
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $84.66 / $119.93 / $169.43	Professional	53	$84.66	$119.93	$169.43
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,213.00 / $2,769.00 / $4,641.00	Facility		$2,213.00	$2,769.00	$4,641.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.49 / $357.44 / $665.65	Professional		$204.49	$357.44	$665.65
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $116.81 / $175.89 / $336.15	Professional	53	$116.81	$175.89	$336.15
Medica Facility/Professional Facility Modifier Low / Median / High Price $190.80 / $382.22 / $1,319.88	Facility		$190.80	$382.22	$1,319.88
Medica Facility/Professional Facility Modifier 52 Low / Median / High Price $663.66 / $663.66 / $663.66	Facility	52	$663.66	$663.66	$663.66
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $165.92 / $165.92 / $165.92	Facility	53	$165.92	$165.92	$165.92
Medica Facility/Professional Professional Modifier Low / Median / High Price $288.97 / $620.84 / $2,761.67	Professional		$288.97	$620.84	$2,761.67
Medica Facility/Professional Professional Modifier 53 Low / Median / High Price $111.54 / $111.54 / $112.30	Professional	53	$111.54	$111.54	$112.30
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $391.37 / $391.37 / $391.37	Professional		$391.37	$391.37	$391.37
Qualchoice Facility/Professional Professional Modifier 53 Low / Median / High Price $57.86 / $77.14 / $151.72	Professional	53	$57.86	$77.14	$151.72
United Facility/Professional Facility Modifier Low / Median / High Price $1,380.00 / $1,895.00 / $3,041.00	Facility		$1,380.00	$1,895.00	$3,041.00
United Facility/Professional Professional Modifier Low / Median / High Price $237.43 / $425.09 / $743.60	Professional		$237.43	$425.09	$743.60
United Facility/Professional Professional Modifier 53 Low / Median / High Price $165.30 / $165.30 / $267.31	Professional	53	$165.30	$165.30	$267.31