Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $323.77 / $3,055.50 / $7,027.26	Facility		$323.77	$3,055.50	$7,027.26
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $66.59 / $161.88 / $524.91	Facility	52	$66.59	$161.88	$524.91
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $26.64 / $64.75 / $209.96	Facility	53	$26.64	$64.75	$209.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $116.97 / $282.83 / $1,243.32	Professional		$116.97	$282.83	$1,243.32
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,314.00 / $2,550.00 / $4,471.00	Facility		$1,314.00	$2,550.00	$4,471.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $176.44 / $467.67 / $1,480.89	Professional		$176.44	$467.67	$1,480.89
CareSource Facility/Professional Facility Modifier Low / Median / High Price $114.64 / $143.40 / $172.82	Facility		$114.64	$143.40	$172.82
CareSource Facility/Professional Professional Modifier Low / Median / High Price $258.74 / $326.16 / $583.25	Professional		$258.74	$326.16	$583.25
Cigna Facility/Professional Facility Modifier Low / Median / High Price $775.86 / $906.66 / $1,390.84	Facility		$775.86	$906.66	$1,390.84
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $165.11 / $165.11 / $165.11	Facility	52	$165.11	$165.11	$165.11
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $41.28 / $41.28 / $41.28	Facility	53	$41.28	$41.28	$41.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $193.85 / $475.08 / $1,198.60	Professional		$193.85	$475.08	$1,198.60
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $126.61 / $275.20 / $539.29	Facility		$126.61	$275.20	$539.29
Medica Facility/Professional Facility Modifier Low / Median / High Price $132.52 / $310.00 / $2,882.35	Facility		$132.52	$310.00	$2,882.35
Medica Facility/Professional Facility Modifier 52 Low / Median / High Price $442.02 / $442.02 / $442.02	Facility	52	$442.02	$442.02	$442.02
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $110.50 / $110.50 / $110.50	Facility	53	$110.50	$110.50	$110.50
Medica Facility/Professional Professional Modifier Low / Median / High Price $296.33 / $966.10 / $2,132.08	Professional		$296.33	$966.10	$2,132.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $85.00 / $411.97 / $673.83	Professional		$85.00	$411.97	$673.83
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $125.40 / $274.33 / $539.29	Facility		$125.40	$274.33	$539.29
Quartz Facility/Professional Professional Modifier Low / Median / High Price $272.58 / $540.24 / $969.80	Professional		$272.58	$540.24	$969.80
Quartz Facility/Professional Facility Modifier Low / Median / High Price $206.39 / $850.80 / $2,855.25	Facility		$206.39	$850.80	$2,855.25
Quartz Facility/Professional Facility Modifier 52 Low / Median / High Price $165.11 / $442.02 / $442.02	Facility	52	$165.11	$442.02	$442.02
Quartz Facility/Professional Facility Modifier 53 Low / Median / High Price $41.28 / $110.50 / $110.50	Facility	53	$41.28	$110.50	$110.50
Quartz Facility/Professional Professional Modifier Low / Median / High Price $233.22 / $1,213.00 / $2,132.08	Professional		$233.22	$1,213.00	$2,132.08
Security Health Facility/Professional Professional Modifier Low / Median / High Price $545.29 / $684.05 / $1,463.50	Professional		$545.29	$684.05	$1,463.50
United Facility/Professional Facility Modifier Low / Median / High Price $2,976.00 / $3,827.00 / $5,471.00	Facility		$2,976.00	$3,827.00	$5,471.00
United Facility/Professional Professional Modifier Low / Median / High Price $288.00 / $574.54 / $1,224.10	Professional		$288.00	$574.54	$1,224.10