Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $206.11 / $361.40 / $1,894.00	Facility		$206.11	$361.40	$1,894.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $154.58 / $164.63 / $625.44	Facility	54	$154.58	$164.63	$625.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $182.59 / $226.97 / $1,007.00	Professional		$182.59	$226.97	$1,007.00
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $153.41 / $164.63 / $788.64	Professional	54	$153.41	$164.63	$788.64
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 $212.89 / $475.64 / $1,260.60	Professional		$212.89	$475.64	$1,260.60
CareSource Facility/Professional Facility Modifier Low / Median / High Price $196.43 / $250.50 / $319.44	Facility		$196.43	$250.50	$319.44
CareSource Facility/Professional Professional Modifier Low / Median / High Price $204.26 / $214.47 / $282.23	Professional		$204.26	$214.47	$282.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $601.95 / $703.42 / $1,079.07	Facility		$601.95	$703.42	$1,079.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $289.73 / $665.95 / $1,032.41	Professional		$289.73	$665.95	$1,032.41
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $199.26 / $264.39 / $485.10	Facility		$199.26	$264.39	$485.10
Medica Facility/Professional Facility Modifier Low / Median / High Price $199.26 / $324.14 / $1,449.00	Facility		$199.26	$324.14	$1,449.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $232.49 / $485.09 / $1,670.64	Professional		$232.49	$485.09	$1,670.64
Molina Facility/Professional Professional Modifier Low / Median / High Price $31.53 / $180.36 / $482.31	Professional		$31.53	$180.36	$482.31
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $199.26 / $259.63 / $485.10	Facility		$199.26	$259.63	$485.10
Quartz Facility/Professional Professional Modifier Low / Median / High Price $442.65 / $542.76 / $805.14	Professional		$442.65	$542.76	$805.14
Quartz Facility/Professional Facility Modifier Low / Median / High Price $264.92 / $264.92 / $998.32	Facility		$264.92	$264.92	$998.32
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $681.37 / $681.37 / $681.37	Facility	54	$681.37	$681.37	$681.37
Quartz Facility/Professional Professional Modifier Low / Median / High Price $412.31 / $986.50 / $1,670.64	Professional		$412.31	$986.50	$1,670.64
Security Health Facility/Professional Professional Modifier Low / Median / High Price $657.86 / $1,361.35 / $1,445.86	Professional		$657.86	$1,361.35	$1,445.86
United Facility/Professional Facility Modifier Low / Median / High Price $790.92 / $1,297.00 / $2,202.90	Facility		$790.92	$1,297.00	$2,202.90
United Facility/Professional Professional Modifier Low / Median / High Price $232.49 / $462.86 / $961.64	Professional		$232.49	$462.86	$961.64