Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $231.55 / $1,665.08 / $3,707.94	Facility		$231.55	$1,665.08	$3,707.94
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,194.89 / $2,874.82 / $3,856.17	Facility	50	$1,194.89	$2,874.82	$3,856.17
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $20.50 / $46.31 / $180.75	Facility	53	$20.50	$46.31	$180.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.52 / $326.32 / $1,588.30	Professional		$102.52	$326.32	$1,588.30
Aetna Facility/Professional Professional Modifier 22 Low / Median / High Price $141.52 / $482.41 / $1,551.25	Professional	22	$141.52	$482.41	$1,551.25
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $156.91 / $636.63 / $2,310.00	Professional	50	$156.91	$636.63	$2,310.00
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $20.50 / $46.31 / $141.51	Professional	53	$20.50	$46.31	$141.51
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,139.00 / $2,479.00 / $4,441.52	Facility		$1,139.00	$2,479.00	$4,441.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $139.69 / $251.07 / $637.10	Professional		$139.69	$251.07	$637.10
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $232.84 / $376.60 / $955.66	Professional	50	$232.84	$376.60	$955.66
CareSource Facility/Professional Facility Modifier Low / Median / High Price $104.23 / $125.08 / $156.35	Facility		$104.23	$125.08	$156.35
CareSource Facility/Professional Professional Modifier Low / Median / High Price $220.24 / $231.25 / $300.76	Professional		$220.24	$231.25	$300.76
Cigna Facility/Professional Facility Modifier Low / Median / High Price $666.83 / $779.24 / $1,195.38	Facility		$666.83	$779.24	$1,195.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.91 / $468.79 / $1,104.20	Professional		$204.91	$468.79	$1,104.20
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $102.52 / $226.01 / $433.32	Facility		$102.52	$226.01	$433.32
Medica Facility/Professional Facility Modifier Low / Median / High Price $108.39 / $297.26 / $3,026.00	Facility		$108.39	$297.26	$3,026.00
Medica Facility/Professional Facility Modifier 50 Low / Median / High Price $1,210.86 / $3,020.36 / $3,714.20	Facility	50	$1,210.86	$3,020.36	$3,714.20
Medica Facility/Professional Professional Modifier Low / Median / High Price $268.24 / $616.19 / $4,050.50	Professional		$268.24	$616.19	$4,050.50
Medica Facility/Professional Professional Modifier 50 Low / Median / High Price $243.84 / $355.39 / $365.77	Professional	50	$243.84	$355.39	$365.77
Molina Facility/Professional Professional Modifier Low / Median / High Price $134.13 / $236.55 / $551.40	Professional		$134.13	$236.55	$551.40
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $102.52 / $226.01 / $433.32	Facility		$102.52	$226.01	$433.32
Quartz Facility/Professional Professional Modifier Low / Median / High Price $253.98 / $474.50 / $820.67	Professional		$253.98	$474.50	$820.67
Quartz Facility/Professional Facility Modifier Low / Median / High Price $504.08 / $504.08 / $982.04	Facility		$504.08	$504.08	$982.04
Quartz Facility/Professional Facility Modifier 53 Low / Median / High Price $100.82 / $100.82 / $100.82	Facility	53	$100.82	$100.82	$100.82
Quartz Facility/Professional Professional Modifier Low / Median / High Price $261.41 / $1,052.00 / $4,050.50	Professional		$261.41	$1,052.00	$4,050.50
Security Health Facility/Professional Professional Modifier Low / Median / High Price $376.45 / $649.27 / $1,455.04	Professional		$376.45	$649.27	$1,455.04
United Facility/Professional Facility Modifier Low / Median / High Price $2,367.00 / $3,088.30 / $4,295.00	Facility		$2,367.00	$3,088.30	$4,295.00
United Facility/Professional Professional Modifier Low / Median / High Price $252.91 / $469.04 / $1,041.54	Professional		$252.91	$469.04	$1,041.54