Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $151.43 / $947.00 / $2,152.80	Facility		$151.43	$947.00	$2,152.80
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $3,019.68 / $3,019.68 / $3,019.68	Facility	50	$3,019.68	$3,019.68	$3,019.68
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $65.84 / $195.23 / $568.20	Facility	52	$65.84	$195.23	$568.20
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $26.34 / $78.09 / $227.28	Facility	53	$26.34	$78.09	$227.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.44 / $322.48 / $858.67	Professional		$87.44	$322.48	$858.67
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,139.00 / $2,479.00 / $4,441.52	Facility		$1,139.00	$2,479.00	$4,441.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.99 / $537.59 / $1,624.62	Professional		$204.99	$537.59	$1,624.62
CareSource Facility/Professional Facility Modifier Low / Median / High Price $101.95 / $154.26 / $154.26	Facility		$101.95	$154.26	$154.26
CareSource Facility/Professional Professional Modifier Low / Median / High Price $290.68 / $404.36 / $625.00	Professional		$290.68	$404.36	$625.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $844.35 / $986.69 / $1,591.49	Facility		$844.35	$986.69	$1,591.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $201.28 / $440.95 / $1,103.95	Professional		$201.28	$440.95	$1,103.95
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $120.20 / $226.58 / $491.89	Facility		$120.20	$226.58	$491.89
Medica Facility/Professional Facility Modifier Low / Median / High Price $131.68 / $532.20 / $4,130.00	Facility		$131.68	$532.20	$4,130.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $393.87 / $1,118.00 / $2,038.68	Professional		$393.87	$1,118.00	$2,038.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $85.00 / $334.20 / $790.01	Professional		$85.00	$334.20	$790.01
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $120.20 / $226.58 / $491.89	Facility		$120.20	$226.58	$491.89
Quartz Facility/Professional Professional Modifier Low / Median / High Price $245.02 / $447.71 / $1,086.53	Professional		$245.02	$447.71	$1,086.53
Quartz Facility/Professional Facility Modifier Low / Median / High Price $627.00 / $627.00 / $627.00	Facility		$627.00	$627.00	$627.00
Quartz Facility/Professional Facility Modifier 52 Low / Median / High Price $388.74 / $388.74 / $388.74	Facility	52	$388.74	$388.74	$388.74
Quartz Facility/Professional Facility Modifier 53 Low / Median / High Price $97.18 / $97.18 / $97.18	Facility	53	$97.18	$97.18	$97.18
Quartz Facility/Professional Professional Modifier Low / Median / High Price $191.15 / $675.27 / $2,804.09	Professional		$191.15	$675.27	$2,804.09
Security Health Facility/Professional Professional Modifier Low / Median / High Price $608.63 / $643.24 / $1,895.92	Professional		$608.63	$643.24	$1,895.92
United Facility/Professional Facility Modifier Low / Median / High Price $2,257.00 / $3,088.30 / $4,295.00	Facility		$2,257.00	$3,088.30	$4,295.00
United Facility/Professional Professional Modifier Low / Median / High Price $366.55 / $1,045.28 / $1,381.87	Professional		$366.55	$1,045.28	$1,381.87