Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $56.54 / $195.20 / $383.04	Facility		$56.54	$195.20	$383.04
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $130.28 / $314.25 / $536.64	Facility	25	$130.28	$314.25	$536.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.51 / $89.17 / $242.00	Professional		$53.51	$89.17	$242.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $62.22 / $108.36 / $257.70	Professional	25	$62.22	$108.36	$257.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $66.20 / $115.67 / $203.18	Professional		$66.20	$115.67	$203.18
CareSource Facility/Professional Facility Modifier Low / Median / High Price $62.19 / $78.81 / $93.96	Facility		$62.19	$78.81	$93.96
CareSource Facility/Professional Professional Modifier Low / Median / High Price $83.88 / $100.66 / $140.27	Professional		$83.88	$100.66	$140.27
Cigna Facility/Professional Facility Modifier Low / Median / High Price $242.40 / $283.27 / $376.48	Facility		$242.40	$283.27	$376.48
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $55.05 / $55.05 / $55.05	Facility	62	$55.05	$55.05	$55.05
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $8.81 / $8.81 / $8.81	Facility	AS	$8.81	$8.81	$8.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.82 / $161.96 / $256.58	Professional		$62.82	$161.96	$256.58
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $46.41 / $73.38 / $143.08	Facility		$46.41	$73.38	$143.08
Medica Facility/Professional Facility Modifier Low / Median / High Price $47.61 / $75.09 / $143.27	Facility		$47.61	$75.09	$143.27
Medica Facility/Professional Facility Modifier 25 Low / Median / High Price $50.00 / $147.75 / $417.21	Facility	25	$50.00	$147.75	$417.21
Medica Facility/Professional Facility Modifier 62 Low / Median / High Price $149.93 / $186.38 / $186.38	Facility	62	$149.93	$186.38	$186.38
Medica Facility/Professional Facility Modifier AS Low / Median / High Price $23.99 / $29.82 / $29.82	Facility	AS	$23.99	$29.82	$29.82
Medica Facility/Professional Professional Modifier Low / Median / High Price $78.02 / $182.99 / $413.45	Professional		$78.02	$182.99	$413.45
Medica Facility/Professional Professional Modifier 25 Low / Median / High Price $136.94 / $184.25 / $223.86	Professional	25	$136.94	$184.25	$223.86
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.54 / $85.00 / $139.59	Professional		$41.54	$85.00	$139.59
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $47.61 / $74.06 / $143.08	Facility		$47.61	$74.06	$143.08
Quartz Facility/Professional Professional Modifier Low / Median / High Price $114.31 / $197.00 / $276.02	Professional		$114.31	$197.00	$276.02
Quartz Facility/Professional Facility Modifier Low / Median / High Price $88.08 / $124.44 / $630.00	Facility		$88.08	$124.44	$630.00
Quartz Facility/Professional Facility Modifier 62 Low / Median / High Price $55.05 / $77.78 / $186.38	Facility	62	$55.05	$77.78	$186.38
Quartz Facility/Professional Facility Modifier AS Low / Median / High Price $8.81 / $12.44 / $29.82	Facility	AS	$8.81	$12.44	$29.82
Quartz Facility/Professional Professional Modifier Low / Median / High Price $82.12 / $390.33 / $567.54	Professional		$82.12	$390.33	$567.54
Security Health Facility/Professional Professional Modifier Low / Median / High Price $86.94 / $134.93 / $188.14	Professional		$86.94	$134.93	$188.14
United Facility/Professional Professional Modifier Low / Median / High Price $73.08 / $119.39 / $197.06	Professional		$73.08	$119.39	$197.06