Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $468.09 / $722.14 / $3,119.00	Facility		$468.09	$722.14	$3,119.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $769.46 / $769.46 / $1,807.00	Facility	50	$769.46	$769.46	$1,807.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $351.07 / $377.77 / $919.85	Facility	54	$351.07	$377.77	$919.85
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $70.20 / $75.55 / $183.97	Facility	55	$70.20	$75.55	$183.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $272.75 / $382.73 / $1,273.61	Professional		$272.75	$382.73	$1,273.61
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $436.08 / $1,022.84 / $3,786.75	Professional	50	$436.08	$1,022.84	$3,786.75
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $233.02 / $351.07 / $1,133.06	Professional	54	$233.02	$351.07	$1,133.06
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $46.79 / $62.04 / $226.61	Professional	55	$46.79	$62.04	$226.61
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 $307.22 / $604.36 / $1,456.91	Professional		$307.22	$604.36	$1,456.91
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $487.03 / $924.33 / $2,228.05	Professional	50	$487.03	$924.33	$2,228.05
CareSource Facility/Professional Facility Modifier Low / Median / High Price $378.89 / $378.89 / $378.89	Facility		$378.89	$378.89	$378.89
CareSource Facility/Professional Professional Modifier Low / Median / High Price $300.05 / $315.05 / $412.24	Professional		$300.05	$315.05	$412.24
Cigna Facility/Professional Facility Modifier Low / Median / High Price $898.42 / $1,049.86 / $1,693.40	Facility		$898.42	$1,049.86	$1,693.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $348.90 / $732.43 / $1,214.85	Professional		$348.90	$732.43	$1,214.85
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $304.63 / $442.87 / $686.45	Facility		$304.63	$442.87	$686.45
Medica Facility/Professional Facility Modifier Low / Median / High Price $305.85 / $589.32 / $4,130.00	Facility		$305.85	$589.32	$4,130.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $323.64 / $719.80 / $2,492.32	Professional		$323.64	$719.80	$2,492.32
Medica Facility/Professional Professional Modifier 50 Low / Median / High Price $2,192.52 / $2,310.36 / $4,001.54	Professional	50	$2,192.52	$2,310.36	$4,001.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.95 / $167.71 / $528.81	Professional		$30.95	$167.71	$528.81
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $304.63 / $454.57 / $756.00	Facility		$304.63	$454.57	$756.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $600.60 / $780.12 / $1,087.90	Professional		$600.60	$780.12	$1,087.90
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,826.65 / $1,826.65 / $1,826.65	Facility		$1,826.65	$1,826.65	$1,826.65
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $979.13 / $979.13 / $979.13	Facility	54	$979.13	$979.13	$979.13
Quartz Facility/Professional Facility Modifier 55 Low / Median / High Price $209.81 / $209.81 / $209.81	Facility	55	$209.81	$209.81	$209.81
Quartz Facility/Professional Professional Modifier Low / Median / High Price $521.09 / $1,510.75 / $2,492.32	Professional		$521.09	$1,510.75	$2,492.32
Security Health Facility/Professional Professional Modifier Low / Median / High Price $968.71 / $3,039.44 / $3,265.52	Professional		$968.71	$3,039.44	$3,265.52
United Facility/Professional Facility Modifier Low / Median / High Price $2,257.00 / $3,088.30 / $4,295.00	Facility		$2,257.00	$3,088.30	$4,295.00
United Facility/Professional Professional Modifier Low / Median / High Price $323.64 / $642.05 / $1,412.70	Professional		$323.64	$642.05	$1,412.70