Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $318.05 / $617.50 / $1,894.00	Facility		$318.05	$617.50	$1,894.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $238.54 / $252.10 / $961.92	Facility	54	$238.54	$252.10	$961.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.16 / $341.24 / $1,391.00	Professional		$275.16	$341.24	$1,391.00
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 $315.94 / $733.97 / $1,846.10	Professional		$315.94	$733.97	$1,846.10
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 $920.04 / $1,075.14 / $1,649.30	Facility		$920.04	$1,075.14	$1,649.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $412.81 / $1,024.69 / $1,578.29	Professional		$412.81	$1,024.69	$1,578.29
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $302.82 / $393.27 / $742.85	Facility		$302.82	$393.27	$742.85
Medica Facility/Professional Facility Modifier Low / Median / High Price $302.82 / $482.81 / $1,449.00	Facility		$302.82	$482.81	$1,449.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $344.41 / $725.93 / $2,559.44	Professional		$344.41	$725.93	$2,559.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $38.65 / $202.77 / $681.31	Professional		$38.65	$202.77	$681.31
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $302.82 / $393.27 / $742.85	Facility		$302.82	$393.27	$742.85
Quartz Facility/Professional Professional Modifier Low / Median / High Price $688.35 / $847.41 / $1,202.59	Professional		$688.35	$847.41	$1,202.59
Quartz Facility/Professional Facility Modifier Low / Median / High Price $264.92 / $264.92 / $1,931.40	Facility		$264.92	$264.92	$1,931.40
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $1,063.92 / $1,063.92 / $1,063.92	Facility	54	$1,063.92	$1,063.92	$1,063.92
Quartz Facility/Professional Professional Modifier Low / Median / High Price $630.29 / $1,490.60 / $2,559.44	Professional		$630.29	$1,490.60	$2,559.44
Security Health Facility/Professional Professional Modifier Low / Median / High Price $988.94 / $2,093.27 / $2,210.28	Professional		$988.94	$2,093.27	$2,210.28
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 $347.91 / $663.61 / $1,439.07	Professional		$347.91	$663.61	$1,439.07