Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $216.54 / $1,904.43 / $3,971.72	Facility		$216.54	$1,904.43	$3,971.72
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $58.35 / $166.26 / $529.36	Facility	52	$58.35	$166.26	$529.36
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $23.34 / $66.50 / $211.74	Facility	53	$23.34	$66.50	$211.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.09 / $292.06 / $1,164.50	Professional		$98.09	$292.06	$1,164.50
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,139.00 / $2,419.00 / $4,441.52	Facility		$1,139.00	$2,419.00	$4,441.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.59 / $440.51 / $1,442.44	Professional		$154.59	$440.51	$1,442.44
CareSource Facility/Professional Facility Modifier Low / Median / High Price $99.37 / $125.01 / $149.72	Facility		$99.37	$125.01	$149.72
CareSource Facility/Professional Professional Modifier Low / Median / High Price $259.08 / $326.69 / $581.79	Professional		$259.08	$326.69	$581.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $786.68 / $919.30 / $1,410.22	Facility		$786.68	$919.30	$1,410.22
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $143.59 / $143.59 / $143.59	Facility	52	$143.59	$143.59	$143.59
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $35.90 / $35.90 / $35.90	Facility	53	$35.90	$35.90	$35.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.23 / $431.48 / $1,214.76	Professional		$169.23	$431.48	$1,214.76
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $105.52 / $264.02 / $496.78	Facility		$105.52	$264.02	$496.78
Medica Facility/Professional Facility Modifier Low / Median / High Price $105.86 / $291.72 / $3,242.00	Facility		$105.86	$291.72	$3,242.00
Medica Facility/Professional Facility Modifier 52 Low / Median / High Price $381.48 / $381.48 / $381.48	Facility	52	$381.48	$381.48	$381.48
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $95.37 / $95.37 / $95.37	Facility	53	$95.37	$95.37	$95.37
Medica Facility/Professional Professional Modifier Low / Median / High Price $322.06 / $952.18 / $2,156.80	Professional		$322.06	$952.18	$2,156.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $85.00 / $392.06 / $673.83	Professional		$85.00	$392.06	$673.83
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $105.52 / $264.02 / $496.78	Facility		$105.52	$264.02	$496.78
Quartz Facility/Professional Professional Modifier Low / Median / High Price $235.24 / $494.35 / $973.21	Professional		$235.24	$494.35	$973.21
Quartz Facility/Professional Facility Modifier Low / Median / High Price $179.49 / $611.20 / $611.20	Facility		$179.49	$611.20	$611.20
Quartz Facility/Professional Facility Modifier 52 Low / Median / High Price $143.59 / $381.48 / $381.48	Facility	52	$143.59	$381.48	$381.48
Quartz Facility/Professional Facility Modifier 53 Low / Median / High Price $35.90 / $95.37 / $95.37	Facility	53	$35.90	$95.37	$95.37
Quartz Facility/Professional Professional Modifier Low / Median / High Price $202.06 / $1,001.37 / $2,156.80	Professional		$202.06	$1,001.37	$2,156.80
Security Health Facility/Professional Professional Modifier Low / Median / High Price $410.47 / $897.52 / $1,483.21	Professional		$410.47	$897.52	$1,483.21
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 $308.93 / $641.19 / $1,516.81	Professional		$308.93	$641.19	$1,516.81