Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,335.73 / $9,771.90 / $23,617.65	Facility		$2,335.73	$9,771.90	$23,617.65
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $350.24 / $655.29 / $1,167.86	Facility	52	$350.24	$655.29	$1,167.86
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $140.10 / $262.12 / $467.15	Facility	53	$140.10	$262.12	$467.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $632.69 / $1,044.25 / $6,383.50	Professional		$632.69	$1,044.25	$6,383.50
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $7,084.00 / $11,791.00 / $18,603.00	Facility		$7,084.00	$11,791.00	$18,603.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $619.86 / $1,436.87 / $3,696.36	Professional		$619.86	$1,436.87	$3,696.36
CareSource Facility/Professional Facility Modifier Low / Median / High Price $631.60 / $789.50 / $968.97	Facility		$631.60	$789.50	$968.97
CareSource Facility/Professional Professional Modifier Low / Median / High Price $617.02 / $797.90 / $1,497.73	Professional		$617.02	$797.90	$1,497.73
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,643.64 / $1,920.73 / $2,946.44	Facility		$1,643.64	$1,920.73	$2,946.44
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $594.13 / $594.13 / $594.13	Facility	52	$594.13	$594.13	$594.13
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $148.53 / $148.53 / $148.53	Facility	53	$148.53	$148.53	$148.53
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $74.27 / $74.27 / $74.27	Facility	AS	$74.27	$74.27	$74.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $805.00 / $2,194.59 / $2,615.28	Professional		$805.00	$2,194.59	$2,615.28
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $640.30 / $867.80 / $1,942.50	Facility		$640.30	$867.80	$1,942.50
Medica Facility/Professional Facility Modifier Low / Median / High Price $640.73 / $1,252.33 / $13,615.89	Facility		$640.73	$1,252.33	$13,615.89
Medica Facility/Professional Facility Modifier 22 Low / Median / High Price $10,412.37 / $10,412.37 / $10,412.37	Facility	22	$10,412.37	$10,412.37	$10,412.37
Medica Facility/Professional Facility Modifier 52 Low / Median / High Price $12,302.24 / $12,302.24 / $12,302.24	Facility	52	$12,302.24	$12,302.24	$12,302.24
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $3,075.56 / $3,075.56 / $3,075.56	Facility	53	$3,075.56	$3,075.56	$3,075.56
Medica Facility/Professional Facility Modifier AS Low / Median / High Price $1,537.78 / $1,537.78 / $1,537.78	Facility	AS	$1,537.78	$1,537.78	$1,537.78
Medica Facility/Professional Professional Modifier Low / Median / High Price $692.56 / $1,619.19 / $4,971.47	Professional		$692.56	$1,619.19	$4,971.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $65.50 / $572.27 / $1,353.66	Professional		$65.50	$572.27	$1,353.66
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $640.30 / $867.80 / $1,942.50	Facility		$640.30	$867.80	$1,942.50
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,203.59 / $1,605.20 / $2,645.75	Professional		$1,203.59	$1,605.20	$2,645.75
Quartz Facility/Professional Facility Modifier Low / Median / High Price $753.07 / $16,223.75 / $16,223.75	Facility		$753.07	$16,223.75	$16,223.75
Quartz Facility/Professional Facility Modifier 52 Low / Median / High Price $594.13 / $12,302.24 / $12,302.24	Facility	52	$594.13	$12,302.24	$12,302.24
Quartz Facility/Professional Facility Modifier 53 Low / Median / High Price $148.53 / $3,075.56 / $3,075.56	Facility	53	$148.53	$3,075.56	$3,075.56
Quartz Facility/Professional Facility Modifier AS Low / Median / High Price $74.27 / $1,537.78 / $1,537.78	Facility	AS	$74.27	$1,537.78	$1,537.78
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,112.89 / $3,099.70 / $4,971.47	Professional		$1,112.89	$3,099.70	$4,971.47
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,273.39 / $5,394.02 / $5,394.02	Professional		$2,273.39	$5,394.02	$5,394.02
United Facility/Professional Facility Modifier Low / Median / High Price $8,627.00 / $12,373.00 / $15,903.00	Facility		$8,627.00	$12,373.00	$15,903.00
United Facility/Professional Professional Modifier Low / Median / High Price $671.65 / $1,300.82 / $2,797.48	Professional		$671.65	$1,300.82	$2,797.48