Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $289.57 / $622.66 / $1,164.33	Facility		$289.57	$622.66	$1,164.33
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $217.18 / $228.47 / $873.26	Facility	54	$217.18	$228.47	$873.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $246.08 / $322.39 / $1,419.50	Professional		$246.08	$322.39	$1,419.50
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $209.54 / $230.84 / $967.85	Professional	54	$209.54	$230.84	$967.85
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 $283.94 / $579.13 / $1,759.15	Professional		$283.94	$579.13	$1,759.15
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 $836.24 / $977.21 / $1,499.07	Facility		$836.24	$977.21	$1,499.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $350.00 / $931.54 / $1,579.61	Professional		$350.00	$931.54	$1,579.61
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $220.00 / $354.23 / $660.84	Facility		$220.00	$354.23	$660.84
Medica Facility/Professional Facility Modifier Low / Median / High Price $246.83 / $435.54 / $1,449.00	Facility		$246.83	$435.54	$1,449.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $306.76 / $657.30 / $2,320.96	Professional		$306.76	$657.30	$2,320.96
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 $220.00 / $348.43 / $660.84	Facility		$220.00	$348.43	$660.84
Quartz Facility/Professional Professional Modifier Low / Median / High Price $623.35 / $767.39 / $1,133.83	Professional		$623.35	$767.39	$1,133.83
Quartz Facility/Professional Facility Modifier Low / Median / High Price $264.92 / $264.92 / $1,407.36	Facility		$264.92	$264.92	$1,407.36
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $969.60 / $969.60 / $969.60	Facility	54	$969.60	$969.60	$969.60
Quartz Facility/Professional Professional Modifier Low / Median / High Price $572.26 / $1,349.85 / $2,320.96	Professional		$572.26	$1,349.85	$2,320.96
Security Health Facility/Professional Professional Modifier Low / Median / High Price $891.03 / $1,909.23 / $2,006.82	Professional		$891.03	$1,909.23	$2,006.82
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 $293.16 / $599.91 / $1,296.93	Professional		$293.16	$599.91	$1,296.93