Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $164.39 / $1,760.00 / $5,389.00	Facility		$164.39	$1,760.00	$5,389.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,645.50 / $2,485.00 / $5,493.00	Facility	50	$1,645.50	$2,485.00	$5,493.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $18.30 / $26.47 / $50.02	Facility	53	$18.30	$26.47	$50.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.73 / $210.91 / $661.08	Professional		$93.73	$210.91	$661.08
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 $141.84 / $329.58 / $1,402.63	Professional	50	$141.84	$329.58	$1,402.63
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $18.75 / $40.76 / $61.96	Professional	53	$18.75	$40.76	$61.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $131.91 / $161.13 / $243.81	Professional		$131.91	$161.13	$243.81
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $237.05 / $241.71 / $281.58	Professional	50	$237.05	$241.71	$281.58
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $821.00 / $1,963.00 / $4,852.00	Facility		$821.00	$1,963.00	$4,852.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $105.52 / $144.97 / $243.50	Professional		$105.52	$144.97	$243.50
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $158.29 / $219.40 / $365.25	Professional	50	$158.29	$219.40	$365.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $121.52 / $238.90 / $443.10	Professional		$121.52	$238.90	$443.10
Medica Facility/Professional Facility Modifier Low / Median / High Price $109.60 / $260.52 / $1,751.00	Facility		$109.60	$260.52	$1,751.00
Medica Facility/Professional Facility Modifier 50 Low / Median / High Price $1,564.02 / $1,564.02 / $1,620.18	Facility	50	$1,564.02	$1,564.02	$1,620.18
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $100.82 / $100.82 / $100.82	Facility	53	$100.82	$100.82	$100.82
Medica Facility/Professional Professional Modifier Low / Median / High Price $243.09 / $424.48 / $4,050.50	Professional		$243.09	$424.48	$4,050.50
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $185.31 / $185.31 / $185.31	Professional		$185.31	$185.31	$185.31
United Facility/Professional Facility Modifier Low / Median / High Price $899.00 / $1,632.00 / $2,664.00	Facility		$899.00	$1,632.00	$2,664.00
United Facility/Professional Professional Modifier Low / Median / High Price $231.86 / $365.47 / $510.72	Professional		$231.86	$365.47	$510.72