Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $49.95 / $165.49 / $721.62	Facility		$49.95	$165.49	$721.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.64 / $110.26 / $535.40	Professional		$47.64	$110.26	$535.40
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $153.38 / $323.74 / $734.90	Professional	50	$153.38	$323.74	$734.90
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 $63.67 / $120.12 / $262.83	Professional		$63.67	$120.12	$262.83
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $103.06 / $181.94 / $394.26	Professional	50	$103.06	$181.94	$394.26
CareSource Facility/Professional Facility Modifier Low / Median / High Price $45.12 / $68.13 / $68.13	Facility		$45.12	$68.13	$68.13
CareSource Facility/Professional Professional Modifier Low / Median / High Price $76.04 / $109.11 / $168.65	Professional		$76.04	$109.11	$168.65
Cigna Facility/Professional Facility Modifier Low / Median / High Price $214.47 / $250.62 / $404.24	Facility		$214.47	$250.62	$404.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $76.89 / $153.88 / $323.98	Professional		$76.89	$153.88	$323.98
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $43.44 / $76.70 / $158.13	Facility		$43.44	$76.70	$158.13
Medica Facility/Professional Facility Modifier Low / Median / High Price $47.54 / $130.36 / $1,778.00	Facility		$47.54	$130.36	$1,778.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $101.74 / $249.92 / $518.83	Professional		$101.74	$249.92	$518.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $58.91 / $162.93 / $250.69	Professional		$58.91	$162.93	$250.69
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $43.22 / $76.70 / $158.13	Facility		$43.22	$76.70	$158.13
Quartz Facility/Professional Professional Modifier Low / Median / High Price $109.83 / $170.25 / $274.50	Professional		$109.83	$170.25	$274.50
Quartz Facility/Professional Facility Modifier Low / Median / High Price $276.80 / $276.80 / $276.80	Facility		$276.80	$276.80	$276.80
Quartz Facility/Professional Professional Modifier Low / Median / High Price $65.63 / $341.55 / $647.52	Professional		$65.63	$341.55	$647.52
Security Health Facility/Professional Professional Modifier Low / Median / High Price $158.41 / $264.52 / $455.78	Professional		$158.41	$264.52	$455.78
United Facility/Professional Facility Modifier Low / Median / High Price $1,008.00 / $1,423.00 / $2,202.90	Facility		$1,008.00	$1,423.00	$2,202.90
United Facility/Professional Professional Modifier Low / Median / High Price $91.54 / $249.92 / $383.67	Professional		$91.54	$249.92	$383.67