Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $210.75 / $307.92 / $471.49	Facility		$210.75	$307.92	$471.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.61 / $210.75 / $352.67	Professional		$204.61	$210.75	$352.67
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $255.76 / $255.76 / $456.28	Facility		$255.76	$255.76	$456.28
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.61 / $204.61 / $306.91	Professional		$204.61	$204.61	$306.91
CareSource Facility/Professional Facility Modifier Low / Median / High Price $280.13 / $302.82 / $327.38	Facility		$280.13	$302.82	$327.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $204.61 / $499.20 / $713.57	Facility		$204.61	$499.20	$713.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $209.10 / $320.66 / $364.39	Professional		$209.10	$320.66	$364.39
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $204.61 / $205.28 / $316.13	Facility		$204.61	$205.28	$316.13
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $307.92 / $409.22 / $409.22	Professional		$307.92	$409.22	$409.22
Medica Facility/Professional Facility Modifier Low / Median / High Price $205.28 / $222.01 / $1,026.20	Facility		$205.28	$222.01	$1,026.20
Medica Facility/Professional Professional Modifier Low / Median / High Price $153.96 / $205.28 / $281.07	Professional		$153.96	$205.28	$281.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $65.00 / $205.24	Professional		$50.00	$65.00	$205.24
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $204.61 / $205.28 / $316.13	Facility		$204.61	$205.28	$316.13
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $307.92 / $409.22 / $409.22	Professional		$307.92	$409.22	$409.22
Quartz Facility/Professional Professional Modifier Low / Median / High Price $204.61 / $249.05 / $686.18	Professional		$204.61	$249.05	$686.18
Quartz Facility/Professional Facility Modifier Low / Median / High Price $820.96 / $820.96 / $1,026.20	Facility		$820.96	$820.96	$1,026.20
Quartz Facility/Professional Professional Modifier Low / Median / High Price $200.06 / $204.61 / $204.61	Professional		$200.06	$204.61	$204.61
Security Health Facility/Professional Professional Modifier Low / Median / High Price $245.12 / $287.27 / $297.26	Professional		$245.12	$287.27	$297.26
United Facility/Professional Professional Modifier Low / Median / High Price $184.15 / $204.61 / $245.53	Professional		$184.15	$204.61	$245.53