Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.53 / $197.91 / $233.10	Facility		$104.53	$197.91	$233.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.94 / $106.02 / $174.36	Professional		$102.94	$106.02	$174.36
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $128.68 / $190.42 / $229.53	Facility		$128.68	$190.42	$229.53
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.94 / $102.94 / $130.72	Professional		$102.94	$102.94	$130.72
CareSource Facility/Professional Facility Modifier Low / Median / High Price $140.94 / $140.94 / $164.70	Facility		$140.94	$140.94	$164.70
Cigna Facility/Professional Facility Modifier Low / Median / High Price $102.94 / $318.08 / $454.68	Facility		$102.94	$318.08	$454.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.94 / $116.15 / $140.94	Professional		$102.94	$116.15	$140.94
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $101.49 / $101.49 / $226.67	Facility		$101.49	$101.49	$226.67
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $152.24 / $205.88 / $205.88	Professional		$152.24	$205.88	$205.88
Medica Facility/Professional Facility Modifier Low / Median / High Price $101.49 / $101.49 / $223.84	Facility		$101.49	$101.49	$223.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $101.49 / $101.49 / $205.88	Professional		$101.49	$101.49	$205.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $85.00 / $270.06	Professional		$50.00	$85.00	$270.06
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $101.49 / $101.49 / $226.67	Facility		$101.49	$101.49	$226.67
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $152.24 / $205.88 / $205.88	Professional		$152.24	$205.88	$205.88
Quartz Facility/Professional Professional Modifier Low / Median / High Price $102.94 / $136.88 / $383.90	Professional		$102.94	$136.88	$383.90
Quartz Facility/Professional Facility Modifier Low / Median / High Price $697.75 / $697.75 / $697.75	Facility		$697.75	$697.75	$697.75
Quartz Facility/Professional Professional Modifier Low / Median / High Price $102.94 / $102.94 / $102.94	Professional		$102.94	$102.94	$102.94
Security Health Facility/Professional Professional Modifier Low / Median / High Price $144.53 / $144.53 / $144.53	Professional		$144.53	$144.53	$144.53
United Facility/Professional Facility Modifier Low / Median / High Price $102.93 / $102.93 / $102.93	Facility		$102.93	$102.93	$102.93
United Facility/Professional Professional Modifier Low / Median / High Price $102.94 / $102.94 / $154.41	Professional		$102.94	$102.94	$154.41