Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.90 / $977.09 / $3,381.80	Facility		$104.90	$977.09	$3,381.80
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,238.28 / $1,498.00 / $5,499.56	Facility	50	$1,238.28	$1,498.00	$5,499.56
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $17.62 / $37.95 / $54.53	Facility	53	$17.62	$37.95	$54.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.09 / $210.62 / $425.46	Professional		$95.09	$210.62	$425.46
Aetna Facility/Professional Professional Modifier 22 Low / Median / High Price $141.52 / $141.52 / $191.19	Professional	22	$141.52	$141.52	$191.19
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $150.56 / $637.91 / $2,482.80	Professional	50	$150.56	$637.91	$2,482.80
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $19.60 / $37.95 / $62.49	Professional	53	$19.60	$37.95	$62.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $143.09 / $143.09 / $205.01	Professional		$143.09	$143.09	$205.01
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $322.25 / $322.25 / $322.25	Professional	50	$322.25	$322.25	$322.25
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,041.00 / $2,067.00 / $2,978.00	Facility		$1,041.00	$2,067.00	$2,978.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $78.14 / $91.93 / $234.11	Professional		$78.14	$91.93	$234.11
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $117.21 / $137.88 / $351.17	Professional	50	$117.21	$137.88	$351.17
CareSource Facility/Professional Facility Modifier Low / Median / High Price $102.21 / $137.97 / $168.86	Facility		$102.21	$137.97	$168.86
CareSource Facility/Professional Professional Modifier Low / Median / High Price $133.79 / $253.28 / $330.84	Professional		$133.79	$253.28	$330.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $141.51 / $188.07 / $188.07	Facility		$141.51	$188.07	$188.07
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $37.61 / $37.61 / $37.61	Facility	53	$37.61	$37.61	$37.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $121.72 / $245.52 / $466.96	Professional		$121.72	$245.52	$466.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $279.27	Professional		$32.34	$32.34	$279.27
United Facility/Professional Facility Modifier Low / Median / High Price $391.00 / $1,275.00 / $3,394.00	Facility		$391.00	$1,275.00	$3,394.00
United Facility/Professional Professional Modifier Low / Median / High Price $220.93 / $322.69 / $450.58	Professional		$220.93	$322.69	$450.58