Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $107.87 / $204.65 / $241.06	Facility		$107.87	$204.65	$241.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.73 / $107.87 / $241.04	Professional		$104.73	$107.87	$241.04
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $130.91 / $193.75 / $233.55	Facility		$130.91	$193.75	$233.55
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.73 / $104.73 / $133.00	Professional		$104.73	$104.73	$133.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $143.38 / $143.38 / $167.57	Facility		$143.38	$143.38	$167.57
Cigna Facility/Professional Facility Modifier Low / Median / High Price $104.73 / $244.19 / $349.06	Facility		$104.73	$244.19	$349.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.73 / $148.86 / $169.16	Professional		$104.73	$148.86	$169.16
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $104.73 / $104.95 / $230.95	Facility		$104.73	$104.95	$230.95
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $157.43 / $209.46 / $209.46	Professional		$157.43	$209.46	$209.46
Medica Facility/Professional Facility Modifier Low / Median / High Price $104.95 / $104.95 / $230.95	Facility		$104.95	$104.95	$230.95
Medica Facility/Professional Professional Modifier Low / Median / High Price $104.95 / $104.95 / $209.46	Professional		$104.95	$104.95	$209.46
Molina Facility/Professional Professional Modifier Low / Median / High Price $65.00 / $85.00 / $100.50	Professional		$65.00	$85.00	$100.50
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $104.73 / $104.95 / $230.95	Facility		$104.73	$104.95	$230.95
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $157.43 / $209.46 / $209.46	Professional		$157.43	$209.46	$209.46
Quartz Facility/Professional Professional Modifier Low / Median / High Price $104.73 / $133.66 / $342.10	Professional		$104.73	$133.66	$342.10
Quartz Facility/Professional Facility Modifier Low / Median / High Price $502.50 / $502.50 / $502.50	Facility		$502.50	$502.50	$502.50
Quartz Facility/Professional Professional Modifier Low / Median / High Price $104.73 / $104.73 / $104.73	Professional		$104.73	$104.73	$104.73
Security Health Facility/Professional Professional Modifier Low / Median / High Price $147.04 / $147.04 / $147.04	Professional		$147.04	$147.04	$147.04
United Facility/Professional Professional Modifier Low / Median / High Price $104.73 / $104.73 / $143.40	Professional		$104.73	$104.73	$143.40