Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $302.50 / $645.95 / $1,894.00	Facility		$302.50	$645.95	$1,894.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $226.88 / $245.96 / $936.96	Facility	54	$226.88	$245.96	$936.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $273.85 / $327.94 / $1,363.16	Professional		$273.85	$327.94	$1,363.16
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 $310.27 / $698.07 / $1,757.11	Professional		$310.27	$698.07	$1,757.11
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 $896.61 / $1,047.76 / $1,607.30	Facility		$896.61	$1,047.76	$1,607.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $385.75 / $997.94 / $1,540.39	Professional		$385.75	$997.94	$1,540.39
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $287.08 / $382.50 / $717.73	Facility		$287.08	$382.50	$717.73
Medica Facility/Professional Facility Modifier Low / Median / High Price $287.08 / $462.10 / $1,449.00	Facility		$287.08	$462.10	$1,449.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $340.81 / $751.10 / $2,500.16	Professional		$340.81	$751.10	$2,500.16
Molina Facility/Professional Professional Modifier Low / Median / High Price $31.53 / $147.84 / $691.33	Professional		$31.53	$147.84	$691.33
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $287.08 / $382.50 / $717.73	Facility		$287.08	$382.50	$717.73
Quartz Facility/Professional Professional Modifier Low / Median / High Price $670.80 / $817.34 / $1,171.94	Professional		$670.80	$817.34	$1,171.94
Quartz Facility/Professional Facility Modifier Low / Median / High Price $264.92 / $264.92 / $1,467.84	Facility		$264.92	$264.92	$1,467.84
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $1,009.86 / $1,009.86 / $1,009.86	Facility	54	$1,009.86	$1,009.86	$1,009.86
Quartz Facility/Professional Professional Modifier Low / Median / High Price $615.16 / $1,426.95 / $2,500.16	Professional		$615.16	$1,426.95	$2,500.16
Security Health Facility/Professional Professional Modifier Low / Median / High Price $948.88 / $1,986.07 / $2,157.23	Professional		$948.88	$1,986.07	$2,157.23
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 $340.45 / $679.74 / $1,408.23	Professional		$340.45	$679.74	$1,408.23