Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $288.85 / $614.25 / $1,894.00	Facility		$288.85	$614.25	$1,894.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $216.64 / $236.98 / $899.24	Facility	54	$216.64	$236.98	$899.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.25 / $331.19 / $1,379.77	Professional		$269.25	$331.19	$1,379.77
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 $303.06 / $666.58 / $1,686.75	Professional		$303.06	$666.58	$1,686.75
CareSource Facility/Professional Facility Modifier Low / Median / High Price $276.88 / $319.44 / $415.32	Facility		$276.88	$319.44	$415.32
CareSource Facility/Professional Professional Modifier Low / Median / High Price $294.49 / $309.20 / $409.67	Professional		$294.49	$309.20	$409.67
Cigna Facility/Professional Facility Modifier Low / Median / High Price $863.27 / $1,008.80 / $1,547.53	Facility		$863.27	$1,008.80	$1,547.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $377.18 / $917.43 / $1,482.88	Professional		$377.18	$917.43	$1,482.88
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $273.00 / $369.68 / $682.50	Facility		$273.00	$369.68	$682.50
Medica Facility/Professional Facility Modifier Low / Median / High Price $273.00 / $455.83 / $1,449.00	Facility		$273.00	$455.83	$1,449.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $334.29 / $688.61 / $2,406.08	Professional		$334.29	$688.61	$2,406.08
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 $273.00 / $369.68 / $682.50	Facility		$273.00	$369.68	$682.50
Quartz Facility/Professional Professional Modifier Low / Median / High Price $641.54 / $781.70 / $1,120.83	Professional		$641.54	$781.70	$1,120.83
Quartz Facility/Professional Facility Modifier Low / Median / High Price $264.92 / $264.92 / $1,399.20	Facility		$264.92	$264.92	$1,399.20
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $956.89 / $956.89 / $956.89	Facility	54	$956.89	$956.89	$956.89
Quartz Facility/Professional Professional Modifier Low / Median / High Price $592.21 / $1,379.45 / $2,406.08	Professional		$592.21	$1,379.45	$2,406.08
Security Health Facility/Professional Professional Modifier Low / Median / High Price $915.37 / $1,896.85 / $2,076.73	Professional		$915.37	$1,896.85	$2,076.73
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 $325.17 / $603.84 / $1,373.74	Professional		$325.17	$603.84	$1,373.74