Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.00 / $42.00 / $42.00	Facility		$42.00	$42.00	$42.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.04 / $42.00 / $157.88	Professional		$32.04	$42.00	$157.88
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $53.42 / $53.42 / $97.22	Facility		$53.42	$53.42	$97.22
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $49.68 / $53.42 / $65.70	Professional		$49.68	$53.42	$65.70
CareSource Facility/Professional Facility Modifier Low / Median / High Price $53.42 / $114.32 / $114.32	Facility		$53.42	$114.32	$114.32
Cigna Facility/Professional Facility Modifier Low / Median / High Price $142.38 / $166.38 / $221.13	Facility		$142.38	$166.38	$221.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.75 / $77.34 / $100.50	Professional		$39.75	$77.34	$100.50
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $42.00 / $42.00 / $62.58	Facility		$42.00	$42.00	$62.58
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $53.42 / $53.42 / $53.42	Professional		$53.42	$53.42	$53.42
Medica Facility/Professional Facility Modifier Low / Median / High Price $33.71 / $42.00 / $64.26	Facility		$33.71	$42.00	$64.26
Medica Facility/Professional Professional Modifier Low / Median / High Price $31.12 / $33.21 / $84.01	Professional		$31.12	$33.21	$84.01
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $131.77	Professional		$50.00	$70.00	$131.77
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $42.00 / $42.00 / $62.58	Facility		$42.00	$42.00	$62.58
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $53.42 / $53.42 / $53.42	Professional		$53.42	$53.42	$53.42
Quartz Facility/Professional Professional Modifier Low / Median / High Price $53.42 / $80.13 / $158.58	Professional		$53.42	$80.13	$158.58
Quartz Facility/Professional Facility Modifier Low / Median / High Price $103.72 / $108.44 / $250.01	Facility		$103.72	$108.44	$250.01
Quartz Facility/Professional Professional Modifier Low / Median / High Price $39.75 / $233.37 / $266.02	Professional		$39.75	$233.37	$266.02
Security Health Facility/Professional Professional Modifier Low / Median / High Price $53.42 / $53.42 / $53.42	Professional		$53.42	$53.42	$53.42
Security Health Facility/Professional Professional Modifier Low / Median / High Price $36.45 / $53.42 / $53.42	Professional		$36.45	$53.42	$53.42
United Facility/Professional Professional Modifier Low / Median / High Price $22.68 / $31.12 / $51.86	Professional		$22.68	$31.12	$51.86