Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $162.52 / $1,373.29 / $1,894.00	Facility		$162.52	$1,373.29	$1,894.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,976.85 / $3,048.32 / $3,899.34	Facility	50	$1,976.85	$3,048.32	$3,899.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.88 / $200.49 / $1,115.04	Professional		$77.88	$200.49	$1,115.04
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $159.60 / $569.85 / $2,284.19	Professional	50	$159.60	$569.85	$2,284.19
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 $108.50 / $188.07 / $481.02	Professional		$108.50	$188.07	$481.02
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $182.19 / $282.10 / $754.03	Professional	50	$182.19	$282.10	$754.03
CareSource Facility/Professional Facility Modifier Low / Median / High Price $78.52 / $94.22 / $117.90	Facility		$78.52	$94.22	$117.90
CareSource Facility/Professional Professional Modifier Low / Median / High Price $148.35 / $155.77 / $203.88	Professional		$148.35	$155.77	$203.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $442.45 / $517.04 / $793.15	Facility		$442.45	$517.04	$793.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $148.24 / $333.10 / $759.03	Professional		$148.24	$333.10	$759.03
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $81.50 / $165.93 / $344.54	Facility		$81.50	$165.93	$344.54
Medica Facility/Professional Facility Modifier Low / Median / High Price $82.77 / $189.63 / $1,449.00	Facility		$82.77	$189.63	$1,449.00
Medica Facility/Professional Facility Modifier 50 Low / Median / High Price $1,161.05 / $2,366.23 / $3,666.90	Facility	50	$1,161.05	$2,366.23	$3,666.90
Medica Facility/Professional Professional Modifier Low / Median / High Price $184.32 / $425.87 / $2,255.51	Professional		$184.32	$425.87	$2,255.51
Medica Facility/Professional Professional Modifier 50 Low / Median / High Price $827.60 / $827.60 / $827.60	Professional	50	$827.60	$827.60	$827.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $77.22 / $148.14 / $315.53	Professional		$77.22	$148.14	$315.53
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $81.50 / $165.93 / $344.54	Facility		$81.50	$165.93	$344.54
Quartz Facility/Professional Professional Modifier Low / Median / High Price $190.68 / $334.29 / $553.11	Professional		$190.68	$334.29	$553.11
Quartz Facility/Professional Facility Modifier Low / Median / High Price $459.08 / $459.08 / $459.08	Facility		$459.08	$459.08	$459.08
Quartz Facility/Professional Professional Modifier Low / Median / High Price $181.32 / $671.00 / $2,255.51	Professional		$181.32	$671.00	$2,255.51
Security Health Facility/Professional Professional Modifier Low / Median / High Price $350.17 / $529.83 / $1,062.99	Professional		$350.17	$529.83	$1,062.99
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 $175.60 / $361.88 / $773.80	Professional		$175.60	$361.88	$773.80