Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $245.47 / $1,778.28 / $5,248.07	Facility		$245.47	$1,778.28	$5,248.07
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $85.11 / $147.91 / $295.12	Facility	53	$85.11	$147.91	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $316.23 / $794.33	Professional		$169.82	$316.23	$794.33
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $72.44 / $131.83 / $263.03	Professional	53	$72.44	$131.83	$263.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $194.98 / $323.59	Professional		$158.49	$194.98	$323.59
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $117.49 / $117.49 / $117.49	Professional	53	$117.49	$117.49	$117.49
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,584.89 / $2,454.71 / $4,265.80	Facility		$1,584.89	$2,454.71	$4,265.80
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $346.74 / $389.05	Professional		$213.80	$346.74	$389.05
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $91.20 / $169.82 / $323.59	Professional	53	$91.20	$169.82	$323.59
CareSource Facility/Professional Facility Modifier Low / Median / High Price $23.44 / $169.82 / $251.19	Facility		$23.44	$169.82	$251.19
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $213.80 / $426.58	Professional		$39.81	$213.80	$426.58
Cigna Facility/Professional Facility Modifier Low / Median / High Price $371.54 / $371.54 / $1,862.09	Facility		$371.54	$371.54	$1,862.09
Cigna Facility/Professional Facility Modifier 22 Low / Median / High Price $446.68 / $446.68 / $446.68	Facility	22	$446.68	$446.68	$446.68
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $295.12 / $295.12 / $295.12	Facility	52	$295.12	$295.12	$295.12
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $74.13 / $74.13 / $74.13	Facility	53	$74.13	$74.13	$74.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $309.03 / $1,584.89	Professional		$245.47	$309.03	$1,584.89
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $48.98 / $104.71 / $213.80	Professional	53	$48.98	$104.71	$213.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $380.19	Professional		$32.36	$33.11	$380.19
United Facility/Professional Facility Modifier Low / Median / High Price $389.05 / $954.99 / $2,398.83	Facility		$389.05	$954.99	$2,398.83
United Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $323.59 / $562.34	Professional		$181.97	$323.59	$562.34
United Facility/Professional Professional Modifier 53 Low / Median / High Price $43.65 / $95.50 / $177.83	Professional	53	$43.65	$95.50	$177.83