Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $327.27 / $703.58 / $1,894.00	Facility		$327.27	$703.58	$1,894.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $245.45 / $257.00 / $981.41	Facility	54	$245.45	$257.00	$981.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $266.19 / $362.43 / $1,675.80	Professional		$266.19	$362.43	$1,675.80
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,038.72 / $1,038.72 / $1,038.72	Professional	50	$1,038.72	$1,038.72	$1,038.72
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $242.26 / $260.47 / $1,167.79	Professional	54	$242.26	$260.47	$1,167.79
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 $317.95 / $746.71 / $1,897.96	Professional		$317.95	$746.71	$1,897.96
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $476.94 / $1,132.83 / $2,886.02	Professional	50	$476.94	$1,132.83	$2,886.02
CareSource Facility/Professional Facility Modifier Low / Median / High Price $314.54 / $345.99 / $471.81	Facility		$314.54	$345.99	$471.81
CareSource Facility/Professional Professional Modifier Low / Median / High Price $320.58 / $336.61 / $444.09	Professional		$320.58	$336.61	$444.09
Cigna Facility/Professional Facility Modifier Low / Median / High Price $940.77 / $1,099.35 / $1,686.45	Facility		$940.77	$1,099.35	$1,686.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $404.43 / $1,003.88 / $1,611.21	Professional		$404.43	$1,003.88	$1,611.21
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $326.32 / $400.92 / $735.67	Facility		$326.32	$400.92	$735.67
Medica Facility/Professional Facility Modifier Low / Median / High Price $326.32 / $490.91 / $1,370.68	Facility		$326.32	$490.91	$1,370.68
Medica Facility/Professional Professional Modifier Low / Median / High Price $343.17 / $717.89 / $2,607.36	Professional		$343.17	$717.89	$2,607.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $52.59 / $214.81 / $681.31	Professional		$52.59	$214.81	$681.31
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $326.32 / $400.92 / $735.67	Facility		$326.32	$400.92	$735.67
Quartz Facility/Professional Professional Modifier Low / Median / High Price $700.05 / $861.82 / $1,223.04	Professional		$700.05	$861.82	$1,223.04
Quartz Facility/Professional Facility Modifier Low / Median / High Price $264.92 / $264.92 / $1,588.76	Facility		$264.92	$264.92	$1,588.76
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $1,094.65 / $1,094.65 / $1,094.65	Facility	54	$1,094.65	$1,094.65	$1,094.65
Quartz Facility/Professional Professional Modifier Low / Median / High Price $643.45 / $1,518.25 / $2,607.36	Professional		$643.45	$1,518.25	$2,607.36
Security Health Facility/Professional Professional Modifier Low / Median / High Price $999.43 / $2,156.75 / $2,256.41	Professional		$999.43	$2,156.75	$2,256.41
United Facility/Professional Facility Modifier Low / Median / High Price $1,008.00 / $1,370.00 / $2,202.90	Facility		$1,008.00	$1,370.00	$2,202.90
United Facility/Professional Professional Modifier Low / Median / High Price $343.21 / $638.12 / $1,403.86	Professional		$343.21	$638.12	$1,403.86