Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $230.70 / $493.00 / $1,894.00	Facility		$230.70	$493.00	$1,894.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $173.03 / $186.59 / $710.19	Facility	54	$173.03	$186.59	$710.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $213.63 / $248.78 / $924.88	Professional		$213.63	$248.78	$924.88
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 $240.42 / $532.38 / $1,340.04	Professional		$240.42	$532.38	$1,340.04
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 $683.05 / $798.20 / $1,224.45	Facility		$683.05	$798.20	$1,224.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $348.71 / $757.12 / $1,153.07	Professional		$348.71	$757.12	$1,153.07
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $230.70 / $300.61 / $547.78	Facility		$230.70	$300.61	$547.78
Medica Facility/Professional Facility Modifier Low / Median / High Price $230.70 / $354.21 / $1,449.00	Facility		$230.70	$354.21	$1,449.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $265.08 / $547.86 / $1,896.64	Professional		$265.08	$547.86	$1,896.64
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.95 / $180.36 / $501.39	Professional		$28.95	$180.36	$501.39
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $230.70 / $291.07 / $547.78	Facility		$230.70	$291.07	$547.78
Quartz Facility/Professional Professional Modifier Low / Median / High Price $504.40 / $614.59 / $895.21	Professional		$504.40	$614.59	$895.21
Quartz Facility/Professional Facility Modifier Low / Median / High Price $264.92 / $264.92 / $1,117.64	Facility		$264.92	$264.92	$1,117.64
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $764.03 / $764.03 / $764.03	Facility	54	$764.03	$764.03	$764.03
Quartz Facility/Professional Professional Modifier Low / Median / High Price $467.73 / $1,101.05 / $1,896.64	Professional		$467.73	$1,101.05	$1,896.64
Security Health Facility/Professional Professional Modifier Low / Median / High Price $734.68 / $1,521.04 / $1,640.20	Professional		$734.68	$1,521.04	$1,640.20
United Facility/Professional Facility Modifier Low / Median / High Price $618.00 / $1,275.00 / $2,202.90	Facility		$618.00	$1,275.00	$2,202.90
United Facility/Professional Professional Modifier Low / Median / High Price $255.88 / $481.96 / $1,086.08	Professional		$255.88	$481.96	$1,086.08