Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $249.00 / $621.25 / $1,298.77	Facility		$249.00	$621.25	$1,298.77
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $196.72 / $216.80 / $830.40	Facility	54	$196.72	$216.80	$830.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $226.94 / $289.07 / $1,331.00	Professional		$226.94	$289.07	$1,331.00
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 $269.27 / $605.29 / $1,583.68	Professional		$269.27	$605.29	$1,583.68
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 $791.18 / $924.56 / $1,418.30	Facility		$791.18	$924.56	$1,418.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $346.11 / $795.77 / $1,362.31	Professional		$346.11	$795.77	$1,362.31
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $250.03 / $331.33 / $626.03	Facility		$250.03	$331.33	$626.03
Medica Facility/Professional Facility Modifier Low / Median / High Price $250.03 / $407.31 / $1,449.00	Facility		$250.03	$407.31	$1,449.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $291.60 / $617.29 / $2,222.64	Professional		$291.60	$617.29	$2,222.64
Molina Facility/Professional Professional Modifier Low / Median / High Price $31.53 / $147.84 / $586.27	Professional		$31.53	$147.84	$586.27
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $250.03 / $331.33 / $626.03	Facility		$250.03	$331.33	$626.03
Quartz Facility/Professional Professional Modifier Low / Median / High Price $589.86 / $727.85 / $1,086.53	Professional		$589.86	$727.85	$1,086.53
Quartz Facility/Professional Facility Modifier Low / Median / High Price $264.92 / $264.92 / $1,265.57	Facility		$264.92	$264.92	$1,265.57
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $885.90 / $885.90 / $885.90	Facility	54	$885.90	$885.90	$885.90
Quartz Facility/Professional Professional Modifier Low / Median / High Price $542.89 / $1,263.78 / $2,222.64	Professional		$542.89	$1,263.78	$2,222.64
Security Health Facility/Professional Professional Modifier Low / Median / High Price $822.06 / $1,730.73 / $1,910.61	Professional		$822.06	$1,730.73	$1,910.61
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 $291.60 / $563.24 / $1,223.72	Professional		$291.60	$563.24	$1,223.72