Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $109.56 / $109.56 / $109.56	Facility		$109.56	$109.56	$109.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.04 / $101.74 / $140.87	Professional		$79.04	$101.74	$140.87
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $160.30 / $291.75 / $291.75	Facility		$160.30	$291.75	$291.75
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $149.06 / $160.28 / $240.42	Professional		$149.06	$160.28	$240.42
CareSource Facility/Professional Facility Modifier Low / Median / High Price $13.87 / $104.00 / $343.00	Facility		$13.87	$104.00	$343.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $98.45 / $98.45 / $489.47	Facility		$98.45	$98.45	$489.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $98.45 / $186.00 / $232.50	Professional		$98.45	$186.00	$232.50
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $99.78 / $128.22 / $192.34	Facility		$99.78	$128.22	$192.34
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $192.34 / $192.34 / $192.34	Professional		$192.34	$192.34	$192.34
Medica Facility/Professional Facility Modifier Low / Median / High Price $99.78 / $192.34 / $752.92	Facility		$99.78	$192.34	$752.92
Medica Facility/Professional Professional Modifier Low / Median / High Price $78.26 / $96.17 / $208.36	Professional		$78.26	$96.17	$208.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $50.00 / $58.40	Professional		$50.00	$50.00	$58.40
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $99.78 / $160.28 / $192.34	Facility		$99.78	$160.28	$192.34
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $192.34 / $192.34 / $192.34	Professional		$192.34	$192.34	$192.34
Quartz Facility/Professional Professional Modifier Low / Median / High Price $21.16 / $32.34 / $41.99	Professional		$21.16	$32.34	$41.99
Quartz Facility/Professional Facility Modifier Low / Median / High Price $98.45 / $313.04 / $752.92	Facility		$98.45	$313.04	$752.92
Quartz Facility/Professional Professional Modifier Low / Median / High Price $98.45 / $98.45 / $98.45	Professional		$98.45	$98.45	$98.45
Security Health Facility/Professional Professional Modifier Low / Median / High Price $160.28 / $160.28 / $160.28	Professional		$160.28	$160.28	$160.28
Security Health Facility/Professional Professional Modifier Low / Median / High Price $160.28 / $160.28 / $160.28	Professional		$160.28	$160.28	$160.28
United Facility/Professional Facility Modifier Low / Median / High Price $7.32 / $64.84 / $106.43	Facility		$7.32	$64.84	$106.43
United Facility/Professional Professional Modifier Low / Median / High Price $62.61 / $93.91 / $199.56	Professional		$62.61	$93.91	$199.56