Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $933.25 / $3,630.78	Facility		$112.20	$933.25	$3,630.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $218.78 / $588.84	Professional		$77.62	$218.78	$588.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $45.71 / $45.71 / $85.11	Professional	52	$45.71	$45.71	$85.11
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $26.30 / $34.67 / $34.67	Professional	53	$26.30	$34.67	$34.67
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $173.78 / $281.84	Professional		$70.79	$173.78	$281.84
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $54.95 / $54.95 / $54.95	Professional	52	$54.95	$54.95	$54.95
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,412.54 / $2,570.40 / $15,848.93	Facility		$1,412.54	$2,570.40	$15,848.93
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $199.53 / $371.54	Professional		$95.50	$199.53	$371.54
CareSource Facility/Professional Facility Modifier Low / Median / High Price $72.44 / $100.00 / $138.04	Facility		$72.44	$100.00	$138.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $204.17 / $281.84	Professional		$93.33	$204.17	$281.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $162.18 / $1,318.26	Facility		$134.90	$162.18	$1,318.26
Cigna Facility/Professional Facility Modifier 22 Low / Median / High Price $162.18 / $162.18 / $162.18	Facility	22	$162.18	$162.18	$162.18
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $109.65 / $109.65 / $109.65	Facility	52	$109.65	$109.65	$109.65
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $27.54 / $27.54 / $27.54	Facility	53	$27.54	$27.54	$27.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $239.88 / $1,258.93	Professional		$120.23	$239.88	$1,258.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
United Facility/Professional Facility Modifier Low / Median / High Price $389.05 / $954.99 / $3,388.44	Facility		$389.05	$954.99	$3,388.44
United Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $190.55 / $338.84	Professional		$95.50	$190.55	$338.84