Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $433.37 / $4,191.50 / $6,538.81	Facility		$433.37	$4,191.50	$6,538.81
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $27.31 / $86.67 / $359.79	Facility	53	$27.31	$86.67	$359.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $139.58 / $589.87 / $3,289.50	Professional		$139.58	$589.87	$3,289.50
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,905.00 / $3,496.00 / $5,962.00	Facility		$1,905.00	$3,496.00	$5,962.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $306.83 / $754.75 / $2,333.14	Professional		$306.83	$754.75	$2,333.14
CareSource Facility/Professional Facility Modifier Low / Median / High Price $152.81 / $231.17 / $231.17	Facility		$152.81	$231.17	$231.17
CareSource Facility/Professional Professional Modifier Low / Median / High Price $459.76 / $638.54 / $986.99	Professional		$459.76	$638.54	$986.99
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,342.67 / $1,569.01 / $2,530.77	Facility		$1,342.67	$1,569.01	$2,530.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $303.02 / $662.47 / $1,744.61	Professional		$303.02	$662.47	$1,744.61
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $147.10 / $342.07 / $885.47	Facility		$147.10	$342.07	$885.47
Medica Facility/Professional Facility Modifier Low / Median / High Price $176.52 / $964.51 / $5,639.00	Facility		$176.52	$964.51	$5,639.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $687.67 / $1,716.30 / $2,673.68	Professional		$687.67	$1,716.30	$2,673.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $85.00 / $529.72 / $1,188.78	Professional		$85.00	$529.72	$1,188.78
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $147.10 / $342.07 / $885.47	Facility		$147.10	$342.07	$885.47
Quartz Facility/Professional Professional Modifier Low / Median / High Price $367.91 / $669.37 / $1,721.43	Professional		$367.91	$669.37	$1,721.43
Quartz Facility/Professional Facility Modifier Low / Median / High Price $896.55 / $896.55 / $896.55	Facility		$896.55	$896.55	$896.55
Quartz Facility/Professional Facility Modifier 53 Low / Median / High Price $145.93 / $145.93 / $145.93	Facility	53	$145.93	$145.93	$145.93
Quartz Facility/Professional Professional Modifier Low / Median / High Price $309.87 / $1,283.60 / $3,676.00	Professional		$309.87	$1,283.60	$3,676.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $597.86 / $1,071.89 / $2,143.73	Professional		$597.86	$1,071.89	$2,143.73
United Facility/Professional Facility Modifier Low / Median / High Price $2,976.00 / $4,155.00 / $5,865.00	Facility		$2,976.00	$4,155.00	$5,865.00
United Facility/Professional Professional Modifier Low / Median / High Price $666.40 / $1,677.31 / $2,673.68	Professional		$666.40	$1,677.31	$2,673.68