Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $290.26 / $615.11 / $1,894.00	Facility		$290.26	$615.11	$1,894.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $217.70 / $228.24 / $861.29	Facility	54	$217.70	$228.24	$861.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.18 / $304.32 / $1,148.38	Professional		$257.18	$304.32	$1,148.38
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 $292.42 / $669.83 / $1,780.18	Professional		$292.42	$669.83	$1,780.18
CareSource Facility/Professional Facility Modifier Low / Median / High Price $319.44 / $319.44 / $319.44	Facility		$319.44	$319.44	$319.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $821.82 / $960.36 / $1,473.22	Facility		$821.82	$960.36	$1,473.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $355.44 / $910.73 / $1,476.74	Professional		$355.44	$910.73	$1,476.74
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $290.26 / $401.80 / $672.55	Facility		$290.26	$401.80	$672.55
Medica Facility/Professional Facility Modifier Low / Median / High Price $290.26 / $452.27 / $1,449.00	Facility		$290.26	$452.27	$1,449.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $316.58 / $660.56 / $2,321.92	Professional		$316.58	$660.56	$2,321.92
Molina Facility/Professional Professional Modifier Low / Median / High Price $38.65 / $193.25 / $602.24	Professional		$38.65	$193.25	$602.24
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $290.26 / $386.14 / $672.55	Facility		$290.26	$386.14	$672.55
Quartz Facility/Professional Professional Modifier Low / Median / High Price $624.00 / $768.19 / $1,135.01	Professional		$624.00	$768.19	$1,135.01
Quartz Facility/Professional Facility Modifier Low / Median / High Price $264.92 / $264.92 / $1,412.48	Facility		$264.92	$264.92	$1,412.48
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $972.78 / $972.78 / $972.78	Facility	54	$972.78	$972.78	$972.78
Quartz Facility/Professional Professional Modifier Low / Median / High Price $567.41 / $1,384.20 / $2,321.92	Professional		$567.41	$1,384.20	$2,321.92
Security Health Facility/Professional Professional Modifier Low / Median / High Price $907.31 / $1,896.57 / $1,989.80	Professional		$907.31	$1,896.57	$1,989.80
United Facility/Professional Facility Modifier Low / Median / High Price $1,034.00 / $1,423.00 / $2,202.90	Facility		$1,034.00	$1,423.00	$2,202.90
United Facility/Professional Professional Modifier Low / Median / High Price $316.58 / $603.89 / $1,309.49	Professional		$316.58	$603.89	$1,309.49