Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $307.42 / $694.94 / $3,119.00	Facility		$307.42	$694.94	$3,119.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $849.15 / $849.15 / $849.15	Facility	50	$849.15	$849.15	$849.15
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $230.57 / $295.58 / $675.36	Facility	54	$230.57	$295.58	$675.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $243.49 / $332.33 / $1,040.57	Professional		$243.49	$332.33	$1,040.57
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $416.31 / $587.26 / $635.69	Professional	50	$416.31	$587.26	$635.69
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $163.00 / $268.94 / $898.95	Professional	54	$163.00	$268.94	$898.95
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $32.60 / $51.64 / $163.86	Professional	55	$32.60	$51.64	$163.86
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 $241.58 / $404.70 / $1,068.94	Professional		$241.58	$404.70	$1,068.94
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $362.37 / $625.29 / $1,648.57	Professional	50	$362.37	$625.29	$1,648.57
CareSource Facility/Professional Facility Modifier Low / Median / High Price $251.02 / $251.02 / $251.02	Facility		$251.02	$251.02	$251.02
CareSource Facility/Professional Professional Modifier Low / Median / High Price $221.13 / $232.19 / $305.82	Professional		$221.13	$232.19	$305.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $652.41 / $762.39 / $1,229.71	Facility		$652.41	$762.39	$1,229.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $258.33 / $496.39 / $888.01	Professional		$258.33	$496.39	$888.01
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $225.65 / $348.07 / $501.42	Facility		$225.65	$348.07	$501.42
Medica Facility/Professional Facility Modifier Low / Median / High Price $225.65 / $432.29 / $4,130.00	Facility		$225.65	$432.29	$4,130.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $281.83 / $587.32 / $4,509.17	Professional		$281.83	$587.32	$4,509.17
Medica Facility/Professional Professional Modifier 50 Low / Median / High Price $538.64 / $538.64 / $538.64	Professional	50	$538.64	$538.64	$538.64
Molina Facility/Professional Professional Modifier Low / Median / High Price $102.76 / $195.56 / $482.25	Professional		$102.76	$195.56	$482.25
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $225.65 / $344.27 / $758.96	Facility		$225.65	$344.27	$758.96
Quartz Facility/Professional Professional Modifier Low / Median / High Price $395.85 / $573.46 / $786.47	Professional		$395.85	$573.46	$786.47
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,436.04 / $1,436.04 / $1,436.04	Facility		$1,436.04	$1,436.04	$1,436.04
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $645.34 / $645.34 / $645.34	Facility	54	$645.34	$645.34	$645.34
Quartz Facility/Professional Professional Modifier Low / Median / High Price $355.28 / $1,044.72 / $4,509.17	Professional		$355.28	$1,044.72	$4,509.17
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,068.35 / $1,987.34 / $2,386.92	Professional		$1,068.35	$1,987.34	$2,386.92
United Facility/Professional Facility Modifier Low / Median / High Price $2,367.00 / $3,088.30 / $4,295.00	Facility		$2,367.00	$3,088.30	$4,295.00
United Facility/Professional Professional Modifier Low / Median / High Price $277.50 / $524.99 / $1,069.15	Professional		$277.50	$524.99	$1,069.15