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 $22.82 / $30.00 / $30.00	Professional		$22.82	$30.00	$30.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $38.04 / $38.04 / $69.23	Facility		$38.04	$38.04	$69.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.38 / $38.04 / $46.78	Professional		$35.38	$38.04	$46.78
CareSource Facility/Professional Facility Modifier Low / Median / High Price $38.04 / $57.06 / $81.41	Facility		$38.04	$57.06	$81.41
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.94 / $47.27 / $88.19	Professional		$39.94	$47.27	$88.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $101.83 / $118.99 / $158.15	Facility		$101.83	$118.99	$158.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $14.68 / $55.31 / $71.58	Professional		$14.68	$55.31	$71.58
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $30.00 / $44.70	Facility		$30.00	$30.00	$44.70
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $38.04 / $38.04 / $38.04	Professional		$38.04	$38.04	$38.04
Medica Facility/Professional Facility Modifier Low / Median / High Price $22.82 / $30.00 / $45.90	Facility		$22.82	$30.00	$45.90
Medica Facility/Professional Professional Modifier Low / Median / High Price $22.16 / $23.65 / $59.83	Professional		$22.16	$23.65	$59.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $93.84	Professional		$50.00	$70.00	$93.84
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $30.00 / $44.70	Facility		$30.00	$30.00	$44.70
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $38.04 / $38.04 / $38.04	Professional		$38.04	$38.04	$38.04
Quartz Facility/Professional Professional Modifier Low / Median / High Price $38.04 / $57.06 / $113.42	Professional		$38.04	$57.06	$113.42
Quartz Facility/Professional Facility Modifier Low / Median / High Price $73.86 / $80.00 / $178.03	Facility		$73.86	$80.00	$178.03
Quartz Facility/Professional Professional Modifier Low / Median / High Price $14.68 / $166.19 / $189.44	Professional		$14.68	$166.19	$189.44
Security Health Facility/Professional Professional Modifier Low / Median / High Price $38.04 / $38.04 / $38.04	Professional		$38.04	$38.04	$38.04
Security Health Facility/Professional Professional Modifier Low / Median / High Price $26.73 / $38.04 / $38.04	Professional		$26.73	$38.04	$38.04
United Facility/Professional Professional Modifier Low / Median / High Price $19.94 / $22.16 / $42.47	Professional		$19.94	$22.16	$42.47