Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $129.22 / $194.75 / $653.83	Facility		$129.22	$194.75	$653.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $119.14 / $165.00 / $402.62	Professional		$119.14	$165.00	$402.62
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $520.60 / $520.60 / $520.60	Professional	25	$520.60	$520.60	$520.60
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $130.00 / $130.00 / $130.00	Professional	52	$130.00	$130.00	$130.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $125.46 / $170.47 / $484.48	Professional		$125.46	$170.47	$484.48
CareSource Facility/Professional Facility Modifier Low / Median / High Price $106.28 / $141.69 / $197.09	Facility		$106.28	$141.69	$197.09
CareSource Facility/Professional Professional Modifier Low / Median / High Price $145.59 / $194.59 / $363.98	Professional		$145.59	$194.59	$363.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $462.27 / $540.20 / $828.69	Facility		$462.27	$540.20	$828.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $212.02 / $575.29	Professional		$100.00	$212.02	$575.29
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $141.10 / $174.40 / $262.20	Facility		$141.10	$174.40	$262.20
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $109.56 / $109.56 / $109.56	Professional		$109.56	$109.56	$109.56
Medica Facility/Professional Facility Modifier Low / Median / High Price $140.78 / $174.40 / $262.20	Facility		$140.78	$174.40	$262.20
Medica Facility/Professional Professional Modifier Low / Median / High Price $137.50 / $258.06 / $1,103.45	Professional		$137.50	$258.06	$1,103.45
Molina Facility/Professional Professional Modifier Low / Median / High Price $87.00 / $158.65 / $343.10	Professional		$87.00	$158.65	$343.10
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $141.10 / $174.86 / $262.20	Facility		$141.10	$174.86	$262.20
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $109.56 / $109.56 / $109.56	Professional		$109.56	$109.56	$109.56
Quartz Facility/Professional Professional Modifier Low / Median / High Price $165.44 / $289.00 / $484.21	Professional		$165.44	$289.00	$484.21
Quartz Facility/Professional Facility Modifier Low / Median / High Price $200.00 / $200.00 / $361.35	Facility		$200.00	$200.00	$361.35
Quartz Facility/Professional Professional Modifier Low / Median / High Price $104.68 / $650.42 / $1,103.45	Professional		$104.68	$650.42	$1,103.45
Security Health Facility/Professional Professional Modifier Low / Median / High Price $219.22 / $411.07 / $478.12	Professional		$219.22	$411.07	$478.12
United Facility/Professional Professional Modifier Low / Median / High Price $124.59 / $210.11 / $465.05	Professional		$124.59	$210.11	$465.05