Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $423.87 / $898.74 / $3,119.00	Facility		$423.87	$898.74	$3,119.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $317.89 / $351.55 / $1,328.87	Facility	54	$317.89	$351.55	$1,328.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $423.87 / $483.69 / $1,877.86	Professional		$423.87	$483.69	$1,877.86
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,740.00 / $4,780.00 / $7,344.00	Facility		$2,740.00	$4,780.00	$7,344.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $446.70 / $978.16 / $2,472.29	Professional		$446.70	$978.16	$2,472.29
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,942.50 / $1,942.50 / $1,942.50	Facility		$1,942.50	$1,942.50	$1,942.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,270.58 / $1,484.77 / $2,277.67	Facility		$1,270.58	$1,484.77	$2,277.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $603.25 / $1,409.20 / $2,126.80	Professional		$603.25	$1,409.20	$2,126.80
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $423.87 / $565.57 / $998.60	Facility		$423.87	$565.57	$998.60
Medica Facility/Professional Facility Modifier Low / Median / High Price $437.07 / $676.26 / $6,669.00	Facility		$437.07	$676.26	$6,669.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $503.37 / $1,026.71 / $3,572.56	Professional		$503.37	$1,026.71	$3,572.56
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.84 / $291.90 / $947.18	Professional		$61.84	$291.90	$947.18
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $423.87 / $563.20 / $998.60	Facility		$423.87	$563.20	$998.60
Quartz Facility/Professional Professional Modifier Low / Median / High Price $956.80 / $1,165.82 / $1,671.60	Professional		$956.80	$1,165.82	$1,671.60
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,722.47 / $1,722.47 / $2,576.15	Facility		$1,722.47	$1,722.47	$2,576.15
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $1,414.67 / $1,414.67 / $1,414.67	Facility	54	$1,414.67	$1,414.67	$1,414.67
Quartz Facility/Professional Professional Modifier Low / Median / High Price $875.13 / $2,032.90 / $3,572.56	Professional		$875.13	$2,032.90	$3,572.56
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,339.32 / $2,774.15 / $3,068.91	Professional		$1,339.32	$2,774.15	$3,068.91
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 $487.58 / $889.38 / $2,035.35	Professional		$487.58	$889.38	$2,035.35