Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $107.90 / $280.24 / $1,894.00	Facility		$107.90	$280.24	$1,894.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $841.10 / $841.10 / $1,093.30	Facility	50	$841.10	$841.10	$1,093.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.26 / $173.49 / $613.49	Professional		$117.26	$173.49	$613.49
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $220.04 / $896.23 / $1,461.24	Professional	50	$220.04	$896.23	$1,461.24
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 $127.68 / $261.27 / $632.41	Professional		$127.68	$261.27	$632.41
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $191.52 / $396.36 / $993.36	Professional	50	$191.52	$396.36	$993.36
CareSource Facility/Professional Facility Modifier Low / Median / High Price $111.29 / $133.55 / $166.94	Facility		$111.29	$133.55	$166.94
CareSource Facility/Professional Professional Modifier Low / Median / High Price $123.23 / $129.38 / $173.14	Professional		$123.23	$129.38	$173.14
Cigna Facility/Professional Facility Modifier Low / Median / High Price $361.35 / $422.27 / $647.77	Facility		$361.35	$422.27	$647.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $182.38 / $397.39 / $603.58	Professional		$182.38	$397.39	$603.58
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $115.67 / $166.13 / $278.75	Facility		$115.67	$166.13	$278.75
Medica Facility/Professional Facility Modifier Low / Median / High Price $118.56 / $188.50 / $1,449.00	Facility		$118.56	$188.50	$1,449.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $152.78 / $316.64 / $1,721.89	Professional		$152.78	$316.64	$1,721.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $58.91 / $162.93 / $259.20	Professional		$58.91	$162.93	$259.20
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $115.67 / $165.09 / $278.75	Facility		$115.67	$165.09	$278.75
Quartz Facility/Professional Professional Modifier Low / Median / High Price $262.50 / $328.68 / $490.65	Professional		$262.50	$328.68	$490.65
Quartz Facility/Professional Facility Modifier Low / Median / High Price $162.84 / $162.84 / $559.12	Facility		$162.84	$162.84	$559.12
Quartz Facility/Professional Professional Modifier Low / Median / High Price $256.99 / $577.30 / $1,721.89	Professional		$256.99	$577.30	$1,721.89
Security Health Facility/Professional Professional Modifier Low / Median / High Price $394.96 / $684.76 / $795.30	Professional		$394.96	$684.76	$795.30
United Facility/Professional Facility Modifier Low / Median / High Price $1,008.00 / $1,370.00 / $2,202.90	Facility		$1,008.00	$1,370.00	$2,202.90
United Facility/Professional Professional Modifier Low / Median / High Price $148.16 / $254.64 / $576.76	Professional		$148.16	$254.64	$576.76