Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.90 / $41.69 / $89.13	Facility		$30.90	$41.69	$89.13
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $125.89 / $125.89 / $125.89	Facility	25	$125.89	$125.89	$125.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $53.70 / $131.83	Professional		$32.36	$53.70	$131.83
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $45.71 / $97.72 / $190.55	Professional	25	$45.71	$97.72	$190.55
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $69.18 / $120.23	Professional		$38.90	$69.18	$120.23
CareSource Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $60.26 / $95.50	Facility		$52.48	$60.26	$95.50
CareSource Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $56.23 / $112.20	Professional		$45.71	$56.23	$112.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $147.91 / $239.88	Facility		$128.82	$147.91	$239.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $100.00 / $162.18	Professional		$39.81	$100.00	$162.18
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $48.98 / $97.72	Facility		$38.02	$48.98	$97.72
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $112.20 / $134.90	Professional		$91.20	$112.20	$134.90
Medica Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $52.48 / $87.10	Facility		$38.90	$52.48	$87.10
Medica Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $70.79 / $346.74	Professional		$39.81	$70.79	$346.74
Medica Facility/Professional Professional Modifier 25 Low / Median / High Price $162.18 / $162.18 / $162.18	Professional	25	$162.18	$162.18	$162.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $85.11	Professional		$32.36	$33.11	$85.11
Quartz Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $104.71 / $144.54	Professional		$69.18	$104.71	$144.54
Quartz Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $239.88 / $239.88	Facility		$91.20	$239.88	$239.88
Quartz Facility/Professional Facility Modifier AS Low / Median / High Price $9.12 / $23.99 / $23.99	Facility	AS	$9.12	$23.99	$23.99
Quartz Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $204.17 / $371.54	Professional		$40.74	$204.17	$371.54
Security Health Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $141.25 / $147.91	Professional		$66.07	$141.25	$147.91
United Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $46.77 / $63.10	Facility		$46.77	$46.77	$63.10
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $61.66 / $104.71	Professional		$38.02	$61.66	$104.71