Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $30.00 / $30.00	Facility		$30.00	$30.00	$30.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.25 / $23.50 / $30.00	Professional		$19.25	$23.50	$30.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $25.00 / $28.92 / $107.08	Professional		$25.00	$28.92	$107.08
CareSource Facility/Professional Facility Modifier Low / Median / High Price $37.90 / $61.10 / $61.10	Facility		$37.90	$61.10	$61.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $68.48 / $80.03 / $122.77	Facility		$68.48	$80.03	$122.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.35 / $67.31 / $76.50	Professional		$29.35	$67.31	$76.50
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $19.25 / $30.00 / $87.50	Facility		$19.25	$30.00	$87.50
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $25.00 / $25.00 / $25.00	Professional		$25.00	$25.00	$25.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $22.50 / $30.00 / $87.50	Facility		$22.50	$30.00	$87.50
Medica Facility/Professional Professional Modifier Low / Median / High Price $12.50 / $16.01 / $77.09	Professional		$12.50	$16.01	$77.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $65.00 / $85.00	Professional		$50.00	$65.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $19.25 / $30.00 / $87.50	Facility		$19.25	$30.00	$87.50
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $25.00 / $25.00 / $25.00	Professional		$25.00	$25.00	$25.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $36.40 / $59.29 / $83.30	Professional		$36.40	$59.29	$83.30
Quartz Facility/Professional Facility Modifier Low / Median / High Price $50.00 / $118.75 / $118.75	Facility		$50.00	$118.75	$118.75
Quartz Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $125.00 / $125.00	Professional		$100.00	$125.00	$125.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $53.24 / $53.24 / $53.24	Professional		$53.24	$53.24	$53.24
Security Health Facility/Professional Professional Modifier Low / Median / High Price $72.66 / $136.50 / $136.50	Professional		$72.66	$136.50	$136.50
United Facility/Professional Professional Modifier Low / Median / High Price $11.25 / $15.00 / $52.50	Professional		$11.25	$15.00	$52.50