Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,022.24 / $4,540.06 / $14,482.00	Facility		$1,022.24	$4,540.06	$14,482.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $204.45 / $204.45 / $502.74	Facility	53	$204.45	$204.45	$502.74
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $766.68 / $766.68 / $1,885.28	Facility	54	$766.68	$766.68	$1,885.28
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $153.34 / $153.34 / $377.06	Facility	55	$153.34	$153.34	$377.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $584.94 / $911.20 / $6,650.00	Professional		$584.94	$911.20	$6,650.00
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $95.58 / $153.34 / $178.43	Professional	55	$95.58	$153.34	$178.43
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $6,538.00 / $9,720.00 / $15,579.70	Facility		$6,538.00	$9,720.00	$15,579.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $673.97 / $1,319.85 / $3,185.61	Professional		$673.97	$1,319.85	$3,185.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,806.75 / $2,111.33 / $3,405.49	Facility		$1,806.75	$2,111.33	$3,405.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $819.58 / $1,654.95 / $2,465.86	Professional		$819.58	$1,654.95	$2,465.86
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $626.86 / $971.63 / $1,395.22	Facility		$626.86	$971.63	$1,395.22
Medica Facility/Professional Facility Modifier Low / Median / High Price $752.23 / $8,225.90 / $15,702.00	Facility		$752.23	$8,225.90	$15,702.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $712.77 / $1,360.02 / $4,758.39	Professional		$712.77	$1,360.02	$4,758.39
Molina Facility/Professional Professional Modifier Low / Median / High Price $62.33 / $348.75 / $1,091.31	Professional		$62.33	$348.75	$1,091.31
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $626.86 / $971.63 / $1,395.22	Facility		$626.86	$971.63	$1,395.22
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,037.53 / $1,565.74 / $2,282.13	Professional		$1,037.53	$1,565.74	$2,282.13
Quartz Facility/Professional Facility Modifier Low / Median / High Price $21,325.00 / $21,325.00 / $21,325.00	Facility		$21,325.00	$21,325.00	$21,325.00
Quartz Facility/Professional Facility Modifier 53 Low / Median / High Price $4,042.62 / $4,042.62 / $4,042.62	Facility	53	$4,042.62	$4,042.62	$4,042.62
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $14,149.17 / $14,149.17 / $14,149.17	Facility	54	$14,149.17	$14,149.17	$14,149.17
Quartz Facility/Professional Facility Modifier 55 Low / Median / High Price $3,031.96 / $3,031.96 / $3,031.96	Facility	55	$3,031.96	$3,031.96	$3,031.96
Quartz Facility/Professional Professional Modifier Low / Median / High Price $735.13 / $2,901.02 / $5,089.60	Professional		$735.13	$2,901.02	$5,089.60
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,542.48 / $4,119.43 / $6,628.14	Professional		$2,542.48	$4,119.43	$6,628.14
United Facility/Professional Facility Modifier Low / Median / High Price $5,729.00 / $11,799.00 / $16,373.00	Facility		$5,729.00	$11,799.00	$16,373.00
United Facility/Professional Professional Modifier Low / Median / High Price $712.49 / $1,414.24 / $2,971.42	Professional		$712.49	$1,414.24	$2,971.42