Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,114.65 / $3,008.00 / $9,245.00	Facility		$1,114.65	$3,008.00	$9,245.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $835.99 / $835.99 / $2,051.33	Facility	54	$835.99	$835.99	$2,051.33
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $167.20 / $167.20 / $410.27	Facility	55	$167.20	$167.20	$410.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $749.66 / $1,092.48 / $3,807.51	Professional		$749.66	$1,092.48	$3,807.51
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $537.54 / $835.99 / $2,729.06	Professional	54	$537.54	$835.99	$2,729.06
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $107.51 / $162.97 / $545.80	Professional	55	$107.51	$162.97	$545.80
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,740.00 / $3,876.00 / $5,962.00	Facility		$2,740.00	$3,876.00	$5,962.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $777.88 / $1,439.16 / $3,643.68	Professional		$777.88	$1,439.16	$3,643.68
CareSource Facility/Professional Facility Modifier Low / Median / High Price $909.21 / $909.21 / $3,084.85	Facility		$909.21	$909.21	$3,084.85
CareSource Facility/Professional Professional Modifier Low / Median / High Price $673.49 / $707.16 / $935.69	Professional		$673.49	$707.16	$935.69
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,968.05 / $2,299.82 / $3,709.52	Facility		$1,968.05	$2,299.82	$3,709.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $892.48 / $1,800.15 / $2,687.25	Professional		$892.48	$1,800.15	$2,687.25
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $716.73 / $1,114.65 / $1,548.76	Facility		$716.73	$1,114.65	$1,548.76
Medica Facility/Professional Facility Modifier Low / Median / High Price $818.48 / $3,353.00 / $8,103.00	Facility		$818.48	$3,353.00	$8,103.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $858.12 / $1,593.77 / $6,925.00	Professional		$858.12	$1,593.77	$6,925.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $62.75 / $421.79 / $1,246.33	Professional		$62.75	$421.79	$1,246.33
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $716.73 / $1,091.31 / $1,596.00	Facility		$716.73	$1,091.31	$1,596.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,325.40 / $1,749.53 / $2,515.10	Professional		$1,325.40	$1,749.53	$2,515.10
Quartz Facility/Professional Facility Modifier Low / Median / High Price $6,887.55 / $6,887.55 / $6,887.55	Facility		$6,887.55	$6,887.55	$6,887.55
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $4,569.92 / $4,569.92 / $4,569.92	Facility	54	$4,569.92	$4,569.92	$4,569.92
Quartz Facility/Professional Facility Modifier 55 Low / Median / High Price $979.27 / $979.27 / $979.27	Facility	55	$979.27	$979.27	$979.27
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,229.46 / $4,778.39 / $6,925.00	Professional		$1,229.46	$4,778.39	$6,925.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,589.83 / $5,002.27 / $7,223.17	Professional		$3,589.83	$5,002.27	$7,223.17
United Facility/Professional Facility Modifier Low / Median / High Price $3,193.00 / $5,918.00 / $7,791.00	Facility		$3,193.00	$5,918.00	$7,791.00
United Facility/Professional Professional Modifier Low / Median / High Price $765.10 / $1,514.30 / $3,189.36	Professional		$765.10	$1,514.30	$3,189.36