Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $26.58 / $26.58 / $26.58	Facility		$26.58	$26.58	$26.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.20 / $26.58 / $104.66	Professional		$25.20	$26.58	$104.66
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $36.27 / $36.27 / $59.85	Facility		$36.27	$36.27	$59.85
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.72 / $33.72 / $39.89	Professional		$33.72	$33.72	$39.89
CareSource Facility/Professional Facility Modifier Low / Median / High Price $32.64 / $32.64 / $77.62	Facility		$32.64	$32.64	$77.62
Cigna Facility/Professional Facility Modifier Low / Median / High Price $97.32 / $113.73 / $174.46	Facility		$97.32	$113.73	$174.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $21.60 / $52.50 / $68.65	Professional		$21.60	$52.50	$68.65
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $25.20 / $36.27 / $38.08	Facility		$25.20	$36.27	$38.08
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $13.10 / $13.10 / $13.10	Professional		$13.10	$13.10	$13.10
Medica Facility/Professional Facility Modifier Low / Median / High Price $26.58 / $36.27 / $169.74	Facility		$26.58	$36.27	$169.74
Medica Facility/Professional Professional Modifier Low / Median / High Price $18.10 / $41.02 / $110.15	Professional		$18.10	$41.02	$110.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $65.00 / $65.00 / $90.00	Professional		$65.00	$65.00	$90.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $25.20 / $36.27 / $38.08	Facility		$25.20	$36.27	$38.08
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $13.10 / $13.10 / $13.10	Professional		$13.10	$13.10	$13.10
Quartz Facility/Professional Professional Modifier Low / Median / High Price $36.27 / $54.76 / $108.40	Professional		$36.27	$54.76	$108.40
Quartz Facility/Professional Facility Modifier Low / Median / High Price $70.84 / $73.63 / $169.74	Facility		$70.84	$73.63	$169.74
Quartz Facility/Professional Professional Modifier Low / Median / High Price $21.60 / $21.60 / $21.60	Professional		$21.60	$21.60	$21.60
Security Health Facility/Professional Professional Modifier Low / Median / High Price $36.27 / $36.27 / $36.27	Professional		$36.27	$36.27	$36.27
Security Health Facility/Professional Facility Modifier Low / Median / High Price $32.45 / $32.45 / $32.45	Facility		$32.45	$32.45	$32.45
Security Health Facility/Professional Professional Modifier Low / Median / High Price $36.27 / $36.27 / $36.27	Professional		$36.27	$36.27	$36.27
United Facility/Professional Professional Modifier Low / Median / High Price $14.17 / $36.27 / $110.15	Professional		$14.17	$36.27	$110.15