Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $92.02 / $209.16 / $240.22	Facility		$92.02	$209.16	$240.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.34 / $92.02 / $126.76	Professional		$89.34	$92.02	$126.76
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $111.68 / $165.28 / $199.23	Facility		$111.68	$165.28	$199.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.34 / $89.34 / $120.60	Professional		$89.34	$89.34	$120.60
CareSource Facility/Professional Facility Modifier Low / Median / High Price $142.94 / $160.81 / $163.75	Facility		$142.94	$160.81	$163.75
Cigna Facility/Professional Facility Modifier Low / Median / High Price $89.34 / $181.71 / $377.75	Facility		$89.34	$181.71	$377.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.34 / $151.22 / $263.14	Professional		$89.34	$151.22	$263.14
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $89.34 / $96.49 / $153.72	Facility		$89.34	$96.49	$153.72
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $156.87 / $178.68 / $178.68	Professional		$156.87	$178.68	$178.68
Medica Facility/Professional Facility Modifier Low / Median / High Price $104.58 / $105.98 / $154.19	Facility		$104.58	$105.98	$154.19
Medica Facility/Professional Professional Modifier Low / Median / High Price $104.58 / $116.42 / $1,160.52	Professional		$104.58	$116.42	$1,160.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $85.00	Professional		$50.00	$70.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $89.34 / $98.28 / $153.72	Facility		$89.34	$98.28	$153.72
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $156.87 / $178.68 / $178.68	Professional		$156.87	$178.68	$178.68
Quartz Facility/Professional Professional Modifier Low / Median / High Price $89.34 / $161.59 / $412.00	Professional		$89.34	$161.59	$412.00
Quartz Facility/Professional Facility Modifier Low / Median / High Price $89.34 / $89.34 / $593.75	Facility		$89.34	$89.34	$593.75
Quartz Facility/Professional Professional Modifier Low / Median / High Price $89.34 / $245.25 / $1,160.52	Professional		$89.34	$245.25	$1,160.52
Security Health Facility/Professional Professional Modifier Low / Median / High Price $125.43 / $125.43 / $182.38	Professional		$125.43	$125.43	$182.38
United Facility/Professional Professional Modifier Low / Median / High Price $89.34 / $94.70 / $125.08	Professional		$89.34	$94.70	$125.08