Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $72.44 / $128.82 / $245.47	Facility		$72.44	$128.82	$245.47
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $79.43 / $213.80 / $380.19	Facility	25	$79.43	$213.80	$380.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $112.20 / $302.00	Professional		$66.07	$112.20	$302.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $75.86 / $134.90 / $316.23	Professional	25	$75.86	$134.90	$316.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $131.83 / $239.88	Professional		$85.11	$131.83	$239.88
CareSource Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $104.71 / $154.88	Facility		$77.62	$104.71	$154.88
CareSource Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $144.54 / $239.88	Professional		$104.71	$144.54	$239.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $346.74 / $549.54	Facility		$263.03	$346.74	$549.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $151.36 / $281.84	Professional		$83.18	$151.36	$281.84
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $97.72 / $173.78	Facility		$67.61	$97.72	$173.78
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $199.53 / $281.84	Professional		$134.90	$199.53	$281.84
Medica Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $100.00 / $208.93	Facility		$66.07	$100.00	$208.93
Medica Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $234.42 / $691.83	Professional		$104.71	$234.42	$691.83
Medica Facility/Professional Professional Modifier 25 Low / Median / High Price $173.78 / $263.03 / $331.13	Professional	25	$173.78	$263.03	$331.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $100.00	Professional		$32.36	$33.11	$100.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $190.55 / $295.12	Professional		$107.15	$190.55	$295.12
Quartz Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $151.36 / $512.86	Facility		$151.36	$151.36	$512.86
Quartz Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $151.36 / $691.83	Professional		$83.18	$151.36	$691.83
Security Health Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $165.96 / $229.09	Professional		$104.71	$165.96	$229.09
United Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $67.61 / $93.33	Facility		$41.69	$67.61	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $117.49 / $213.80	Professional		$74.13	$117.49	$213.80