Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $353.71 / $694.94 / $1,894.00	Facility		$353.71	$694.94	$1,894.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $265.27 / $338.53 / $818.73	Facility	54	$265.27	$338.53	$818.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $243.80 / $353.71 / $1,457.36	Professional		$243.80	$353.71	$1,457.36
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $341.79 / $508.50 / $2,704.50	Professional	50	$341.79	$508.50	$2,704.50
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $188.45 / $272.79 / $867.74	Professional	54	$188.45	$272.79	$867.74
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $37.69 / $54.56 / $173.55	Professional	55	$37.69	$54.56	$173.55
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 $292.97 / $456.68 / $1,103.54	Professional		$292.97	$456.68	$1,103.54
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $439.45 / $698.45 / $1,689.03	Professional	50	$439.45	$698.45	$1,689.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $802.00 / $937.20 / $1,511.67	Facility		$802.00	$937.20	$1,511.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $274.55 / $597.54 / $1,085.43	Professional		$274.55	$597.54	$1,085.43
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $259.08 / $410.16 / $611.20	Facility		$259.08	$410.16	$611.20
Medica Facility/Professional Facility Modifier Low / Median / High Price $272.23 / $508.89 / $4,130.00	Facility		$272.23	$508.89	$4,130.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $337.04 / $637.49 / $2,831.00	Professional		$337.04	$637.49	$2,831.00
Medica Facility/Professional Professional Modifier 50 Low / Median / High Price $1,377.54 / $1,377.54 / $1,848.00	Professional	50	$1,377.54	$1,377.54	$1,848.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.95 / $201.05 / $561.15	Professional		$28.95	$201.05	$561.15
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $259.08 / $410.16 / $743.59	Facility		$259.08	$410.16	$743.59
Quartz Facility/Professional Professional Modifier Low / Median / High Price $454.35 / $694.93 / $953.07	Professional		$454.35	$694.93	$953.07
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,933.96 / $1,933.96 / $1,933.96	Facility		$1,933.96	$1,933.96	$1,933.96
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $740.71 / $740.71 / $740.71	Facility	54	$740.71	$740.71	$740.71
Quartz Facility/Professional Professional Modifier Low / Median / High Price $370.66 / $1,145.50 / $2,831.00	Professional		$370.66	$1,145.50	$2,831.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,064.57 / $2,295.26 / $2,917.57	Professional		$1,064.57	$2,295.26	$2,917.57
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 $337.04 / $594.52 / $1,275.70	Professional		$337.04	$594.52	$1,275.70