Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $352.29 / $665.64 / $1,894.00	Facility		$352.29	$665.64	$1,894.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $264.22 / $289.07 / $1,099.03	Facility	54	$264.22	$289.07	$1,099.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $322.50 / $393.41 / $1,684.20	Professional		$322.50	$393.41	$1,684.20
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 $364.98 / $812.97 / $2,045.64	Professional		$364.98	$812.97	$2,045.64
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 $1,051.60 / $1,228.89 / $1,885.14	Facility		$1,051.60	$1,228.89	$1,885.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $454.08 / $1,096.96 / $1,807.76	Professional		$454.08	$1,096.96	$1,807.76
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $333.54 / $439.11 / $833.85	Facility		$333.54	$439.11	$833.85
Medica Facility/Professional Facility Modifier Low / Median / High Price $333.54 / $545.40 / $1,449.00	Facility		$333.54	$545.40	$1,449.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $402.66 / $836.07 / $2,936.88	Professional		$402.66	$836.07	$2,936.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $52.59 / $249.45 / $812.00	Professional		$52.59	$249.45	$812.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $333.54 / $438.52 / $833.85	Facility		$333.54	$438.52	$833.85
Quartz Facility/Professional Professional Modifier Low / Median / High Price $787.15 / $959.11 / $1,375.21	Professional		$787.15	$959.11	$1,375.21
Quartz Facility/Professional Facility Modifier Low / Median / High Price $264.92 / $264.92 / $1,711.44	Facility		$264.92	$264.92	$1,711.44
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $1,174.11 / $1,174.11 / $1,174.11	Facility	54	$1,174.11	$1,174.11	$1,174.11
Quartz Facility/Professional Professional Modifier Low / Median / High Price $721.94 / $1,674.63 / $2,936.88	Professional		$721.94	$1,674.63	$2,936.88
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,106.74 / $2,312.78 / $2,531.67	Professional		$1,106.74	$2,312.78	$2,531.67
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 $393.38 / $729.40 / $1,657.43	Professional		$393.38	$729.40	$1,657.43