Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $70.23 / $553.16 / $1,894.00	Facility		$70.23	$553.16	$1,894.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $709.20 / $709.20 / $987.60	Facility	50	$709.20	$709.20	$987.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.86 / $104.28 / $433.50	Professional		$40.86	$104.28	$433.50
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $249.86 / $502.50 / $1,275.00	Professional	50	$249.86	$502.50	$1,275.00
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 $54.54 / $94.72 / $240.28	Professional		$54.54	$94.72	$240.28
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $80.95 / $142.08 / $360.42	Professional	50	$80.95	$142.08	$360.42
CareSource Facility/Professional Facility Modifier Low / Median / High Price $38.97 / $46.78 / $58.49	Facility		$38.97	$46.78	$58.49
CareSource Facility/Professional Professional Modifier Low / Median / High Price $67.11 / $70.47 / $92.46	Professional		$67.11	$70.47	$92.46
Cigna Facility/Professional Facility Modifier Low / Median / High Price $201.85 / $235.88 / $361.84	Facility		$201.85	$235.88	$361.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $76.02 / $161.55 / $334.93	Professional		$76.02	$161.55	$334.93
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $40.22 / $70.23 / $148.34	Facility		$40.22	$70.23	$148.34
Medica Facility/Professional Facility Modifier Low / Median / High Price $43.87 / $89.07 / $2,930.60	Facility		$43.87	$89.07	$2,930.60
Medica Facility/Professional Facility Modifier 50 Low / Median / High Price $1,719.11 / $1,719.11 / $1,844.94	Facility	50	$1,719.11	$1,719.11	$1,844.94
Medica Facility/Professional Professional Modifier Low / Median / High Price $90.25 / $199.90 / $1,340.00	Professional		$90.25	$199.90	$1,340.00
Medica Facility/Professional Professional Modifier 50 Low / Median / High Price $207.93 / $207.93 / $207.93	Professional	50	$207.93	$207.93	$207.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.03 / $92.07 / $163.35	Professional		$41.03	$92.07	$163.35
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $40.22 / $70.23 / $148.34	Facility		$40.22	$70.23	$148.34
Quartz Facility/Professional Professional Modifier Low / Median / High Price $94.57 / $159.84 / $249.57	Professional		$94.57	$159.84	$249.57
Quartz Facility/Professional Facility Modifier Low / Median / High Price $93.06 / $93.06 / $187.71	Facility		$93.06	$93.06	$187.71
Quartz Facility/Professional Professional Modifier Low / Median / High Price $97.39 / $320.36 / $1,340.00	Professional		$97.39	$320.36	$1,340.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $139.61 / $241.89 / $441.36	Professional		$139.61	$241.89	$441.36
United Facility/Professional Facility Modifier Low / Median / High Price $1,957.00 / $3,068.00 / $4,295.00	Facility		$1,957.00	$3,068.00	$4,295.00
United Facility/Professional Professional Modifier Low / Median / High Price $86.77 / $155.30 / $335.27	Professional		$86.77	$155.30	$335.27