Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $382.96 / $812.57 / $1,894.00	Facility		$382.96	$812.57	$1,894.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $287.22 / $318.86 / $1,206.22	Facility	54	$287.22	$318.86	$1,206.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $382.96 / $437.30 / $1,763.92	Professional		$382.96	$437.30	$1,763.92
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 $406.93 / $765.92 / $2,232.94	Professional		$406.93	$765.92	$2,232.94
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 $1,151.63 / $1,345.77 / $2,064.44	Facility		$1,151.63	$1,345.77	$2,064.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $545.32 / $1,279.38 / $1,987.50	Professional		$545.32	$1,279.38	$1,987.50
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $379.82 / $487.94 / $902.85	Facility		$379.82	$487.94	$902.85
Medica Facility/Professional Facility Modifier Low / Median / High Price $381.23 / $601.61 / $1,449.00	Facility		$381.23	$601.61	$1,449.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $456.39 / $934.22 / $3,238.80	Professional		$456.39	$934.22	$3,238.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $52.59 / $272.13 / $879.93	Professional		$52.59	$272.13	$879.93
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $379.82 / $481.28 / $902.85	Facility		$379.82	$481.28	$902.85
Quartz Facility/Professional Professional Modifier Low / Median / High Price $866.45 / $1,055.74 / $1,513.75	Professional		$866.45	$1,055.74	$1,513.75
Quartz Facility/Professional Facility Modifier Low / Median / High Price $264.92 / $264.92 / $1,858.84	Facility		$264.92	$264.92	$1,858.84
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $1,275.83 / $1,275.83 / $1,275.83	Facility	54	$1,275.83	$1,275.83	$1,275.83
Quartz Facility/Professional Professional Modifier Low / Median / High Price $793.72 / $1,845.10 / $3,238.80	Professional		$793.72	$1,845.10	$3,238.80
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,210.90 / $2,506.01 / $2,783.41	Professional		$1,210.90	$2,506.01	$2,783.41
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 $447.73 / $814.06 / $1,851.99	Professional		$447.73	$814.06	$1,851.99