Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $308.29 / $3,119.00 / $5,642.82	Facility		$308.29	$3,119.00	$5,642.82
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $81.20 / $81.20 / $154.15	Facility	52	$81.20	$81.20	$154.15
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $32.47 / $61.66 / $153.99	Facility	53	$32.47	$61.66	$153.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $164.50 / $318.20 / $2,490.50	Professional		$164.50	$318.20	$2,490.50
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $35.39 / $78.73 / $179.25	Professional	53	$35.39	$78.73	$179.25
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 $220.53 / $480.28 / $1,302.14	Professional		$220.53	$480.28	$1,302.14
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $126.51 / $239.90 / $665.67	Professional	53	$126.51	$239.90	$665.67
CareSource Facility/Professional Facility Modifier Low / Median / High Price $23.72 / $165.58 / $260.85	Facility		$23.72	$165.58	$260.85
CareSource Facility/Professional Professional Modifier Low / Median / High Price $41.82 / $227.34 / $463.29	Professional		$41.82	$227.34	$463.29
Cigna Facility/Professional Facility Modifier Low / Median / High Price $906.53 / $1,059.34 / $1,625.07	Facility		$906.53	$1,059.34	$1,625.07
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $194.61 / $194.61 / $194.61	Facility	52	$194.61	$194.61	$194.61
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $48.65 / $48.65 / $48.65	Facility	53	$48.65	$48.65	$48.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $244.69 / $468.28 / $1,240.75	Professional		$244.69	$468.28	$1,240.75
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $132.94 / $245.51 / $656.16	Professional	53	$132.94	$245.51	$656.16
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $165.30 / $308.29 / $439.20	Facility		$165.30	$308.29	$439.20
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $277.50 / $277.50 / $277.50	Professional		$277.50	$277.50	$277.50
Medica Facility/Professional Facility Modifier Low / Median / High Price $165.46 / $317.91 / $2,738.06	Facility		$165.46	$317.91	$2,738.06
Medica Facility/Professional Facility Modifier 52 Low / Median / High Price $663.66 / $663.66 / $663.66	Facility	52	$663.66	$663.66	$663.66
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $165.92 / $165.92 / $165.92	Facility	53	$165.92	$165.92	$165.92
Medica Facility/Professional Professional Modifier Low / Median / High Price $359.08 / $1,037.08 / $2,206.53	Professional		$359.08	$1,037.08	$2,206.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $102.76 / $274.03 / $588.93	Professional		$102.76	$274.03	$588.93
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $165.30 / $308.29 / $439.20	Facility		$165.30	$308.29	$439.20
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $277.50 / $277.50 / $277.50	Professional		$277.50	$277.50	$277.50
Quartz Facility/Professional Professional Modifier Low / Median / High Price $379.11 / $693.70 / $1,136.28	Professional		$379.11	$693.70	$1,136.28
Quartz Facility/Professional Facility Modifier Low / Median / High Price $243.26 / $1,063.59 / $1,063.59	Facility		$243.26	$1,063.59	$1,063.59
Quartz Facility/Professional Facility Modifier 52 Low / Median / High Price $194.61 / $663.66 / $663.66	Facility	52	$194.61	$663.66	$663.66
Quartz Facility/Professional Facility Modifier 53 Low / Median / High Price $48.65 / $165.92 / $165.92	Facility	53	$48.65	$165.92	$165.92
Quartz Facility/Professional Professional Modifier Low / Median / High Price $301.45 / $1,182.00 / $2,206.53	Professional		$301.45	$1,182.00	$2,206.53
Quartz Facility/Professional Professional Modifier 53 Low / Median / High Price $346.02 / $346.02 / $656.16	Professional	53	$346.02	$346.02	$656.16
Security Health Facility/Professional Professional Modifier Low / Median / High Price $475.69 / $910.51 / $1,721.54	Professional		$475.69	$910.51	$1,721.54
Security Health Facility/Professional Professional Modifier 53 Low / Median / High Price $143.49 / $237.72 / $514.54	Professional	53	$143.49	$237.72	$514.54
United Facility/Professional Facility Modifier Low / Median / High Price $2,367.00 / $2,910.00 / $4,155.00	Facility		$2,367.00	$2,910.00	$4,155.00
United Facility/Professional Professional Modifier Low / Median / High Price $343.63 / $702.31 / $1,440.53	Professional		$343.63	$702.31	$1,440.53