Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $111.04 / $111.04 / $111.04	Facility		$111.04	$111.04	$111.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $71.75 / $98.08 / $128.78	Professional		$71.75	$98.08	$128.78
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $167.40 / $304.67 / $304.67	Facility		$167.40	$304.67	$304.67
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $155.68 / $155.69 / $225.99	Professional		$155.68	$155.69	$225.99
CareSource Facility/Professional Facility Modifier Low / Median / High Price $12.18 / $91.36 / $358.26	Facility		$12.18	$91.36	$358.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $70.53 / $70.53 / $495.62	Facility		$70.53	$70.53	$495.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $59.95 / $189.38 / $236.72	Professional		$59.95	$189.38	$236.72
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $118.87 / $159.34 / $199.87	Facility		$118.87	$159.34	$199.87
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $203.15 / $203.15 / $203.15	Professional		$203.15	$203.15	$203.15
Medica Facility/Professional Facility Modifier Low / Median / High Price $118.87 / $199.87 / $802.71	Facility		$118.87	$199.87	$802.71
Medica Facility/Professional Professional Modifier Low / Median / High Price $71.58 / $97.61 / $203.15	Professional		$71.58	$97.61	$203.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $65.00 / $121.03	Professional		$50.00	$65.00	$121.03
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $111.04 / $166.56 / $199.87	Facility		$111.04	$166.56	$199.87
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $203.15 / $203.15 / $203.15	Professional		$203.15	$203.15	$203.15
Quartz Facility/Professional Professional Modifier Low / Median / High Price $22.10 / $39.44 / $51.21	Professional		$22.10	$39.44	$51.21
Quartz Facility/Professional Facility Modifier Low / Median / High Price $70.53 / $325.06 / $802.71	Facility		$70.53	$325.06	$802.71
Quartz Facility/Professional Professional Modifier Low / Median / High Price $70.53 / $70.53 / $70.53	Professional		$70.53	$70.53	$70.53
Security Health Facility/Professional Professional Modifier Low / Median / High Price $169.29 / $169.29 / $169.29	Professional		$169.29	$169.29	$169.29
Security Health Facility/Professional Professional Modifier Low / Median / High Price $169.29 / $169.29 / $169.29	Professional		$169.29	$169.29	$169.29
United Facility/Professional Professional Modifier Low / Median / High Price $67.45 / $94.47 / $199.23	Professional		$67.45	$94.47	$199.23