Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $291.22 / $622.60 / $1,894.00	Facility		$291.22	$622.60	$1,894.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $218.42 / $232.97 / $887.12	Facility	54	$218.42	$232.97	$887.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $291.22 / $344.09 / $1,197.75	Professional		$291.22	$344.09	$1,197.75
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 $290.98 / $672.04 / $1,692.90	Professional		$290.98	$672.04	$1,692.90
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 $851.56 / $995.11 / $1,526.53	Facility		$851.56	$995.11	$1,526.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $438.73 / $946.41 / $1,459.13	Professional		$438.73	$946.41	$1,459.13
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $294.97 / $410.43 / $691.78	Facility		$294.97	$410.43	$691.78
Medica Facility/Professional Facility Modifier Low / Median / High Price $294.97 / $466.53 / $1,449.00	Facility		$294.97	$466.53	$1,449.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $349.56 / $757.38 / $2,363.92	Professional		$349.56	$757.38	$2,363.92
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 $294.97 / $407.71 / $691.78	Facility		$294.97	$407.71	$691.78
Quartz Facility/Professional Professional Modifier Low / Median / High Price $633.75 / $773.20 / $1,107.21	Professional		$633.75	$773.20	$1,107.21
Quartz Facility/Professional Facility Modifier Low / Median / High Price $264.92 / $264.92 / $1,413.04	Facility		$264.92	$264.92	$1,413.04
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $970.65 / $970.65 / $970.65	Facility	54	$970.65	$970.65	$970.65
Quartz Facility/Professional Professional Modifier Low / Median / High Price $582.72 / $1,362.35 / $2,363.92	Professional		$582.72	$1,362.35	$2,363.92
Security Health Facility/Professional Professional Modifier Low / Median / High Price $902.10 / $1,915.59 / $2,043.47	Professional		$902.10	$1,915.59	$2,043.47
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 $341.74 / $637.95 / $1,329.78	Professional		$341.74	$637.95	$1,329.78