Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.10 / $643.70 / $1,423.32	Facility		$104.10	$643.70	$1,423.32
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $454.03 / $801.56 / $2,841.00	Facility	50	$454.03	$801.56	$2,841.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $21.79 / $31.66 / $118.58	Facility	52	$21.79	$31.66	$118.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.57 / $101.14 / $429.83	Professional		$43.57	$101.14	$429.83
Aetna Facility/Professional Professional Modifier 22 Low / Median / High Price $283.56 / $637.50 / $956.25	Professional	22	$283.56	$637.50	$956.25
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $63.39 / $233.70 / $789.57	Professional	50	$63.39	$233.70	$789.57
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 $57.56 / $123.58 / $317.98	Professional		$57.56	$123.58	$317.98
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $86.34 / $186.30 / $478.29	Professional	50	$86.34	$186.30	$478.29
CareSource Facility/Professional Facility Modifier Low / Median / High Price $42.86 / $53.39 / $79.44	Facility		$42.86	$53.39	$79.44
CareSource Facility/Professional Professional Modifier Low / Median / High Price $58.61 / $61.54 / $82.46	Professional		$58.61	$61.54	$82.46
Cigna Facility/Professional Facility Modifier Low / Median / High Price $171.21 / $200.08 / $306.92	Facility		$171.21	$200.08	$306.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.36 / $176.68 / $295.64	Professional		$71.36	$176.68	$295.64
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $43.57 / $65.36 / $133.07	Facility		$43.57	$65.36	$133.07
Medica Facility/Professional Facility Modifier Low / Median / High Price $45.48 / $94.98 / $1,368.00	Facility		$45.48	$94.98	$1,368.00
Medica Facility/Professional Facility Modifier 50 Low / Median / High Price $431.91 / $725.60 / $2,520.00	Facility	50	$431.91	$725.60	$2,520.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $73.81 / $167.21 / $482.48	Professional		$73.81	$167.21	$482.48
Medica Facility/Professional Professional Modifier 50 Low / Median / High Price $138.21 / $280.98 / $861.39	Professional	50	$138.21	$280.98	$861.39
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.03 / $85.00 / $156.20	Professional		$41.03	$85.00	$156.20
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $43.57 / $65.36 / $133.07	Facility		$43.57	$65.36	$133.07
Quartz Facility/Professional Professional Modifier Low / Median / High Price $103.71 / $149.60 / $220.34	Professional		$103.71	$149.60	$220.34
Quartz Facility/Professional Facility Modifier Low / Median / High Price $69.12 / $69.12 / $205.87	Facility		$69.12	$69.12	$205.87
Quartz Facility/Professional Facility Modifier 52 Low / Median / High Price $164.70 / $164.70 / $164.70	Facility	52	$164.70	$164.70	$164.70
Quartz Facility/Professional Professional Modifier Low / Median / High Price $97.19 / $273.87 / $482.48	Professional		$97.19	$273.87	$482.48
Security Health Facility/Professional Professional Modifier Low / Median / High Price $136.03 / $283.97 / $414.06	Professional		$136.03	$283.97	$414.06
United Facility/Professional Facility Modifier Low / Median / High Price $1,034.00 / $1,423.00 / $2,202.90	Facility		$1,034.00	$1,423.00	$2,202.90
United Facility/Professional Professional Modifier Low / Median / High Price $68.61 / $121.84 / $270.08	Professional		$68.61	$121.84	$270.08
United Facility/Professional Professional Modifier 50 Low / Median / High Price $80.00 / $80.00 / $85.00	Professional	50	$80.00	$80.00	$85.00