Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $114.35 / $371.12 / $3,411.76	Facility		$114.35	$371.12	$3,411.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.35 / $193.37 / $807.50	Professional		$114.35	$193.37	$807.50
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,905.00 / $3,496.00 / $5,962.00	Facility		$1,905.00	$3,496.00	$5,962.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.27 / $350.11 / $723.76	Professional		$169.27	$350.11	$723.76
CareSource Facility/Professional Facility Modifier Low / Median / High Price $125.04 / $126.55 / $172.75	Facility		$125.04	$126.55	$172.75
CareSource Facility/Professional Professional Modifier Low / Median / High Price $164.94 / $181.43 / $222.08	Professional		$164.94	$181.43	$222.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $482.10 / $563.37 / $864.23	Facility		$482.10	$563.37	$864.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.85 / $262.81 / $494.96	Professional		$138.85	$262.81	$494.96
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $131.69 / $214.42 / $486.06	Facility		$131.69	$214.42	$486.06
Medica Facility/Professional Facility Modifier Low / Median / High Price $135.88 / $329.88 / $3,995.00	Facility		$135.88	$329.88	$3,995.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $162.12 / $317.10 / $1,017.12	Professional		$162.12	$317.10	$1,017.12
Molina Facility/Professional Professional Modifier Low / Median / High Price $97.44 / $182.56 / $395.01	Professional		$97.44	$182.56	$395.01
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $131.69 / $214.42 / $486.06	Facility		$131.69	$214.42	$486.06
Quartz Facility/Professional Professional Modifier Low / Median / High Price $299.45 / $424.09 / $583.09	Professional		$299.45	$424.09	$583.09
Quartz Facility/Professional Facility Modifier Low / Median / High Price $267.02 / $356.87 / $628.24	Facility		$267.02	$356.87	$628.24
Quartz Facility/Professional Professional Modifier Low / Median / High Price $172.58 / $653.85 / $1,338.80	Professional		$172.58	$653.85	$1,338.80
Security Health Facility/Professional Professional Modifier Low / Median / High Price $247.05 / $585.63 / $775.61	Professional		$247.05	$585.63	$775.61
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 $153.41 / $270.14 / $677.00	Professional		$153.41	$270.14	$677.00