Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $285.95 / $612.25 / $1,894.00	Facility		$285.95	$612.25	$1,894.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $214.47 / $231.30 / $881.68	Facility	54	$214.47	$231.30	$881.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $285.95 / $320.19 / $1,315.00	Professional		$285.95	$320.19	$1,315.00
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 $293.20 / $659.92 / $1,659.65	Professional		$293.20	$659.92	$1,659.65
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 $840.75 / $982.48 / $1,507.14	Facility		$840.75	$982.48	$1,507.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $364.86 / $937.49 / $1,446.40	Professional		$364.86	$937.49	$1,446.40
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $272.11 / $360.83 / $680.28	Facility		$272.11	$360.83	$680.28
Medica Facility/Professional Facility Modifier Low / Median / High Price $272.11 / $439.74 / $1,449.00	Facility		$272.11	$439.74	$1,449.00
Medica Facility/Professional Facility Modifier 54 Low / Median / High Price $1,473.00 / $1,473.00 / $1,473.00	Facility	54	$1,473.00	$1,473.00	$1,473.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $324.76 / $673.11 / $2,350.08	Professional		$324.76	$673.11	$2,350.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $38.65 / $182.56 / $593.82	Professional		$38.65	$182.56	$593.82
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $272.11 / $360.83 / $680.28	Facility		$272.11	$360.83	$680.28
Quartz Facility/Professional Professional Modifier Low / Median / High Price $631.79 / $769.82 / $1,103.80	Professional		$631.79	$769.82	$1,103.80
Quartz Facility/Professional Facility Modifier Low / Median / High Price $264.92 / $264.92 / $1,388.36	Facility		$264.92	$264.92	$1,388.36
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $957.94 / $957.94 / $957.94	Facility	54	$957.94	$957.94	$957.94
Quartz Facility/Professional Professional Modifier Low / Median / High Price $577.64 / $1,356.75 / $2,350.08	Professional		$577.64	$1,356.75	$2,350.08
Security Health Facility/Professional Professional Modifier Low / Median / High Price $903.46 / $1,878.25 / $2,025.63	Professional		$903.46	$1,878.25	$2,025.63
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 $95.00 / $586.20 / $1,587.94	Professional		$95.00	$586.20	$1,587.94