Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $217.69 / $1,604.08 / $6,880.70	Facility		$217.69	$1,604.08	$6,880.70
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $108.85 / $248.77 / $802.04	Facility	52	$108.85	$248.77	$802.04
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $43.54 / $99.51 / $320.82	Facility	53	$43.54	$99.51	$320.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $195.20 / $404.66 / $746.04	Professional		$195.20	$404.66	$746.04
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,905.00 / $3,193.00 / $5,962.00	Facility		$1,905.00	$3,193.00	$5,962.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $242.85 / $446.54 / $1,203.67	Professional		$242.85	$446.54	$1,203.67
CareSource Facility/Professional Facility Modifier Low / Median / High Price $187.73 / $234.66 / $283.85	Facility		$187.73	$234.66	$283.85
CareSource Facility/Professional Professional Modifier Low / Median / High Price $397.25 / $501.12 / $898.39	Professional		$397.25	$501.12	$898.39
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,187.68 / $1,387.89 / $2,129.06	Facility		$1,187.68	$1,387.89	$2,129.06
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $270.52 / $270.52 / $270.52	Facility	52	$270.52	$270.52	$270.52
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $67.63 / $67.63 / $67.63	Facility	53	$67.63	$67.63	$67.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $314.88 / $713.02 / $1,765.54	Professional		$314.88	$713.02	$1,765.54
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $205.04 / $418.81 / $780.18	Facility		$205.04	$418.81	$780.18
Medica Facility/Professional Facility Modifier Low / Median / High Price $209.61 / $453.05 / $3,014.84	Facility		$209.61	$453.05	$3,014.84
Medica Facility/Professional Facility Modifier 52 Low / Median / High Price $721.81 / $721.81 / $721.81	Facility	52	$721.81	$721.81	$721.81
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $180.45 / $180.45 / $180.45	Facility	53	$180.45	$180.45	$180.45
Medica Facility/Professional Professional Modifier Low / Median / High Price $434.52 / $1,394.80 / $3,278.48	Professional		$434.52	$1,394.80	$3,278.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $85.00 / $668.94 / $1,090.12	Professional		$85.00	$668.94	$1,090.12
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $207.04 / $412.27 / $780.18	Facility		$207.04	$412.27	$780.18
Quartz Facility/Professional Professional Modifier Low / Median / High Price $442.02 / $849.55 / $1,484.23	Professional		$442.02	$849.55	$1,484.23
Quartz Facility/Professional Facility Modifier Low / Median / High Price $338.16 / $1,154.15 / $3,590.15	Facility		$338.16	$1,154.15	$3,590.15
Quartz Facility/Professional Facility Modifier 52 Low / Median / High Price $270.52 / $721.81 / $721.81	Facility	52	$270.52	$721.81	$721.81
Quartz Facility/Professional Facility Modifier 53 Low / Median / High Price $67.63 / $180.45 / $180.45	Facility	53	$67.63	$180.45	$180.45
Quartz Facility/Professional Professional Modifier Low / Median / High Price $379.45 / $1,794.00 / $3,278.48	Professional		$379.45	$1,794.00	$3,278.48
Security Health Facility/Professional Professional Modifier Low / Median / High Price $885.82 / $1,021.30 / $2,246.84	Professional		$885.82	$1,021.30	$2,246.84
United Facility/Professional Facility Modifier Low / Median / High Price $2,883.00 / $3,242.00 / $6,438.00	Facility		$2,883.00	$3,242.00	$6,438.00
United Facility/Professional Professional Modifier Low / Median / High Price $411.11 / $855.15 / $1,869.96	Professional		$411.11	$855.15	$1,869.96