Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $696.35 / $6,142.00 / $14,482.00	Facility		$696.35	$6,142.00	$14,482.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $12,610.73 / $16,755.70 / $20,840.77	Facility	50	$12,610.73	$16,755.70	$20,840.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $364.29 / $1,722.67 / $3,808.00	Professional		$364.29	$1,722.67	$3,808.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $280.32 / $1,266.08 / $3,782.50	Professional	50	$280.32	$1,266.08	$3,782.50
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $6,538.00 / $10,914.00 / $15,579.70	Facility		$6,538.00	$10,914.00	$15,579.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $493.20 / $2,290.91 / $9,299.98	Professional		$493.20	$2,290.91	$9,299.98
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $821.55 / $3,436.36 / $14,430.51	Professional	50	$821.55	$3,436.36	$14,430.51
CareSource Facility/Professional Facility Modifier Low / Median / High Price $315.77 / $453.00 / $558.38	Facility		$315.77	$453.00	$558.38
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,829.97 / $2,265.67 / $4,618.50	Professional		$1,829.97	$2,265.67	$4,618.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $5,377.88 / $6,284.48 / $8,352.60	Facility		$5,377.88	$6,284.48	$8,352.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $528.19 / $1,320.41 / $7,040.69	Professional		$528.19	$1,320.41	$7,040.69
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $400.09 / $1,756.56 / $3,570.53	Facility		$400.09	$1,756.56	$3,570.53
Medica Facility/Professional Facility Modifier Low / Median / High Price $400.09 / $2,326.23 / $13,822.07	Facility		$400.09	$2,326.23	$13,822.07
Medica Facility/Professional Professional Modifier Low / Median / High Price $2,173.50 / $6,580.64 / $14,571.52	Professional		$2,173.50	$6,580.64	$14,571.52
Medica Facility/Professional Professional Modifier 50 Low / Median / High Price $663.25 / $1,311.01 / $1,810.68	Professional	50	$663.25	$1,311.01	$1,810.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,108.00 / $1,839.67 / $4,758.64	Professional		$1,108.00	$1,839.67	$4,758.64
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $400.09 / $1,756.56 / $3,570.53	Facility		$400.09	$1,756.56	$3,570.53
Quartz Facility/Professional Professional Modifier Low / Median / High Price $836.58 / $2,115.40 / $6,678.46	Professional		$836.58	$2,115.40	$6,678.46
Quartz Facility/Professional Facility Modifier Low / Median / High Price $872.76 / $3,661.25 / $3,661.25	Facility		$872.76	$3,661.25	$3,661.25
Quartz Facility/Professional Professional Modifier Low / Median / High Price $719.86 / $7,542.47 / $14,571.52	Professional		$719.86	$7,542.47	$14,571.52
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,699.60 / $7,467.58 / $13,883.78	Professional		$1,699.60	$7,467.58	$13,883.78
United Facility/Professional Facility Modifier Low / Median / High Price $8,627.00 / $12,373.00 / $15,090.00	Facility		$8,627.00	$12,373.00	$15,090.00
United Facility/Professional Professional Modifier Low / Median / High Price $2,182.08 / $5,555.55 / $8,390.79	Professional		$2,182.08	$5,555.55	$8,390.79