Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $316.06 / $5,437.75 / $13,329.80	Facility		$316.06	$5,437.75	$13,329.80
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $0.97 / $3,119.00 / $8,282.10	Facility	50	$0.97	$3,119.00	$8,282.10
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $77.61 / $207.99 / $689.42	Facility	52	$77.61	$207.99	$689.42
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $31.04 / $83.19 / $275.77	Facility	53	$31.04	$83.19	$275.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $145.77 / $497.20 / $1,738.73	Professional		$145.77	$497.20	$1,738.73
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $777.73 / $872.66 / $3,476.50	Professional	50	$777.73	$872.66	$3,476.50
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $5,060.00 / $7,344.00 / $10,517.23	Facility		$5,060.00	$7,344.00	$10,517.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $287.42 / $696.77 / $2,232.77	Professional		$287.42	$696.77	$2,232.77
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $431.13 / $1,086.15 / $3,349.15	Professional	50	$431.13	$1,086.15	$3,349.15
CareSource Facility/Professional Facility Modifier Low / Median / High Price $146.22 / $220.95 / $220.95	Facility		$146.22	$220.95	$220.95
CareSource Facility/Professional Professional Modifier Low / Median / High Price $353.31 / $495.74 / $766.26	Professional		$353.31	$495.74	$766.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,078.64 / $1,260.48 / $2,033.10	Facility		$1,078.64	$1,260.48	$2,033.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $254.81 / $544.39 / $1,438.88	Professional		$254.81	$544.39	$1,438.88
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $155.21 / $378.24 / $739.28	Facility		$155.21	$378.24	$739.28
Medica Facility/Professional Facility Modifier Low / Median / High Price $177.28 / $588.16 / $8,384.00	Facility		$177.28	$588.16	$8,384.00
Medica Facility/Professional Facility Modifier 50 Low / Median / High Price $2,506.50 / $2,506.50 / $4,060.80	Facility	50	$2,506.50	$2,506.50	$4,060.80
Medica Facility/Professional Professional Modifier Low / Median / High Price $513.34 / $1,528.81 / $3,308.30	Professional		$513.34	$1,528.81	$3,308.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $85.00 / $459.44 / $926.76	Professional		$85.00	$459.44	$926.76
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $155.21 / $367.50 / $739.28	Facility		$155.21	$367.50	$739.28
Quartz Facility/Professional Professional Modifier Low / Median / High Price $354.17 / $637.60 / $1,325.36	Professional		$354.17	$637.60	$1,325.36
Quartz Facility/Professional Facility Modifier Low / Median / High Price $718.52 / $718.52 / $718.52	Facility		$718.52	$718.52	$718.52
Quartz Facility/Professional Facility Modifier 52 Low / Median / High Price $775.66 / $775.66 / $775.66	Facility	52	$775.66	$775.66	$775.66
Quartz Facility/Professional Facility Modifier 53 Low / Median / High Price $193.91 / $193.91 / $193.91	Facility	53	$193.91	$193.91	$193.91
Quartz Facility/Professional Professional Modifier Low / Median / High Price $234.84 / $1,561.00 / $4,715.39	Professional		$234.84	$1,561.00	$4,715.39
Security Health Facility/Professional Professional Modifier Low / Median / High Price $831.14 / $1,051.64 / $2,394.26	Professional		$831.14	$1,051.64	$2,394.26
United Facility/Professional Facility Modifier Low / Median / High Price $4,918.00 / $6,477.00 / $8,384.00	Facility		$4,918.00	$6,477.00	$8,384.00
United Facility/Professional Professional Modifier Low / Median / High Price $466.97 / $1,352.69 / $2,203.16	Professional		$466.97	$1,352.69	$2,203.16