Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $101.14 / $254.91 / $397.77	Facility		$101.14	$254.91	$397.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.00 / $127.06 / $233.60	Professional		$88.00	$127.06	$233.60
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $154.19 / $154.19 / $154.19	Facility		$154.19	$154.19	$154.19
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.36 / $123.36 / $156.66	Professional		$123.36	$123.36	$156.66
CareSource Facility/Professional Facility Modifier Low / Median / High Price $168.89 / $168.89 / $197.38	Facility		$168.89	$168.89	$197.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $123.36 / $300.13 / $429.01	Facility		$123.36	$300.13	$429.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $145.94 / $207.58 / $235.89	Professional		$145.94	$207.58	$235.89
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $96.38 / $135.97 / $271.58	Facility		$96.38	$135.97	$271.58
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $38.74 / $246.72 / $246.72	Professional		$38.74	$246.72	$246.72
Medica Facility/Professional Facility Modifier Low / Median / High Price $91.33 / $135.97 / $401.85	Facility		$91.33	$135.97	$401.85
Medica Facility/Professional Professional Modifier Low / Median / High Price $135.97 / $135.97 / $246.72	Professional		$135.97	$135.97	$246.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $65.00 / $85.00 / $143.26	Professional		$65.00	$85.00	$143.26
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $96.38 / $135.97 / $271.58	Facility		$96.38	$135.97	$271.58
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $38.74 / $246.72 / $246.72	Professional		$38.74	$246.72	$246.72
Quartz Facility/Professional Professional Modifier Low / Median / High Price $123.36 / $180.93 / $354.00	Professional		$123.36	$180.93	$354.00
Quartz Facility/Professional Facility Modifier Low / Median / High Price $123.36 / $123.36 / $505.07	Facility		$123.36	$123.36	$505.07
Quartz Facility/Professional Professional Modifier Low / Median / High Price $123.36 / $123.36 / $123.36	Professional		$123.36	$123.36	$123.36
Security Health Facility/Professional Professional Modifier Low / Median / High Price $131.21 / $173.20 / $173.20	Professional		$131.21	$173.20	$173.20
United Facility/Professional Professional Modifier Low / Median / High Price $123.36 / $123.36 / $168.90	Professional		$123.36	$123.36	$168.90