Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.54 / $169.79 / $1,894.00	Facility		$54.54	$169.79	$1,894.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.54 / $95.97 / $402.80	Professional		$54.54	$95.97	$402.80
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $115.22 / $468.00 / $886.13	Professional	50	$115.22	$468.00	$886.13
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 $73.81 / $156.88 / $398.46	Professional		$73.81	$156.88	$398.46
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $110.73 / $235.33 / $602.02	Professional	50	$110.73	$235.33	$602.02
CareSource Facility/Professional Facility Modifier Low / Median / High Price $53.73 / $67.09 / $109.21	Facility		$53.73	$67.09	$109.21
CareSource Facility/Professional Professional Modifier Low / Median / High Price $74.67 / $78.40 / $104.79	Professional		$74.67	$78.40	$104.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $215.37 / $251.67 / $386.07	Facility		$215.37	$251.67	$386.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.53 / $214.21 / $373.13	Professional		$87.53	$214.21	$373.13
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $54.54 / $82.68 / $169.56	Facility		$54.54	$82.68	$169.56
Medica Facility/Professional Facility Modifier Low / Median / High Price $54.54 / $99.16 / $1,449.00	Facility		$54.54	$99.16	$1,449.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $84.25 / $178.02 / $613.73	Professional		$84.25	$178.02	$613.73
Medica Facility/Professional Professional Modifier 50 Low / Median / High Price $190.79 / $271.64 / $756.55	Professional	50	$190.79	$271.64	$756.55
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.03 / $85.00 / $163.35	Professional		$41.03	$85.00	$163.35
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $54.54 / $82.68 / $169.56	Facility		$54.54	$82.68	$169.56
Quartz Facility/Professional Professional Modifier Low / Median / High Price $130.40 / $190.68 / $281.05	Professional		$130.40	$190.68	$281.05
Quartz Facility/Professional Facility Modifier Low / Median / High Price $93.06 / $93.06 / $258.85	Facility		$93.06	$93.06	$258.85
Quartz Facility/Professional Professional Modifier Low / Median / High Price $116.07 / $345.65 / $613.73	Professional		$116.07	$345.65	$613.73
Security Health Facility/Professional Professional Modifier Low / Median / High Price $181.68 / $353.48 / $522.50	Professional		$181.68	$353.48	$522.50
United Facility/Professional Facility Modifier Low / Median / High Price $953.00 / $1,297.00 / $2,202.90	Facility		$953.00	$1,297.00	$2,202.90
United Facility/Professional Professional Modifier Low / Median / High Price $82.69 / $157.72 / $343.15	Professional		$82.69	$157.72	$343.15