Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $204.17 / $933.25	Facility		$147.91	$204.17	$933.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $165.96 / $416.87	Professional		$114.82	$165.96	$416.87
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $524.81 / $676.08 / $676.08	Professional	25	$524.81	$676.08	$676.08
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $123.03 / $123.03 / $128.82	Professional	52	$123.03	$123.03	$128.82
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $120.23 / $120.23	Facility		$120.23	$120.23	$120.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $173.78 / $478.63	Professional		$123.03	$173.78	$478.63
CareSource Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $147.91 / $269.15	Facility		$107.15	$147.91	$269.15
CareSource Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $229.09 / $380.19	Professional		$144.54	$229.09	$380.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $457.09 / $616.60 / $912.01	Facility		$457.09	$616.60	$912.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $181.97 / $575.44	Professional		$97.72	$181.97	$575.44
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $169.82 / $263.03	Facility		$141.25	$169.82	$263.03
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $275.42 / $416.87	Professional		$199.53	$275.42	$416.87
Medica Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $169.82 / $263.03	Facility		$141.25	$169.82	$263.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $213.80 / $954.99	Professional		$131.83	$213.80	$954.99
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $204.17	Professional		$32.36	$33.11	$204.17
Quartz Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $269.15 / $446.68	Professional		$173.78	$269.15	$446.68
Quartz Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $346.74 / $954.99	Facility		$199.53	$346.74	$954.99
Quartz Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $144.54 / $1,096.48	Professional		$79.43	$144.54	$1,096.48
Security Health Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $407.38 / $549.54	Professional		$199.53	$407.38	$549.54
United Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $162.18 / $213.80	Facility		$144.54	$162.18	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $190.55 / $436.52	Professional		$128.82	$190.55	$436.52