Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $50.83 / $253.88 / $1,339.42	Facility		$50.83	$253.88	$1,339.42
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $12.63 / $31.75 / $114.19	Facility	52	$12.63	$31.75	$114.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.25 / $63.49 / $269.31	Professional		$25.25	$63.49	$269.31
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.79 / $30.60 / $64.06	Professional	52	$11.79	$30.60	$64.06
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 $46.75 / $115.80 / $292.69	Professional		$46.75	$115.80	$292.69
CareSource Facility/Professional Facility Modifier Low / Median / High Price $23.44 / $35.45 / $35.45	Facility		$23.44	$35.45	$35.45
CareSource Facility/Professional Professional Modifier Low / Median / High Price $58.52 / $81.87 / $126.54	Professional		$58.52	$81.87	$126.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $167.61 / $195.86 / $315.92	Facility		$167.61	$195.86	$315.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.18 / $88.76 / $224.33	Professional		$45.18	$88.76	$224.33
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $22.59 / $48.57 / $122.44	Facility		$22.59	$48.57	$122.44
Medica Facility/Professional Facility Modifier Low / Median / High Price $27.11 / $122.44 / $1,642.00	Facility		$27.11	$122.44	$1,642.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $76.91 / $206.25 / $427.50	Professional		$76.91	$206.25	$427.50
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 $22.59 / $48.57 / $122.44	Facility		$22.59	$48.57	$122.44
Quartz Facility/Professional Professional Modifier Low / Median / High Price $56.57 / $104.24 / $218.73	Professional		$56.57	$104.24	$218.73
Quartz Facility/Professional Facility Modifier Low / Median / High Price $112.04 / $112.04 / $112.04	Facility		$112.04	$112.04	$112.04
Quartz Facility/Professional Facility Modifier 52 Low / Median / High Price $89.63 / $89.63 / $89.63	Facility	52	$89.63	$89.63	$89.63
Quartz Facility/Professional Professional Modifier Low / Median / High Price $38.28 / $263.00 / $552.69	Professional		$38.28	$263.00	$552.69
Security Health Facility/Professional Professional Modifier Low / Median / High Price $135.97 / $147.69 / $373.23	Professional		$135.97	$147.69	$373.23
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 $70.98 / $183.37 / $296.25	Professional		$70.98	$183.37	$296.25