Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $84.36 / $165.72 / $190.33	Facility		$84.36	$165.72	$190.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.90 / $82.72 / $98.28	Professional		$81.90	$82.72	$98.28
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $102.38 / $151.52 / $182.64	Facility		$102.38	$151.52	$182.64
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.90 / $81.90 / $110.56	Professional		$81.90	$81.90	$110.56
CareSource Facility/Professional Facility Modifier Low / Median / High Price $131.04 / $147.41 / $150.11	Facility		$131.04	$147.41	$150.11
Cigna Facility/Professional Facility Modifier Low / Median / High Price $81.90 / $156.16 / $270.89	Facility		$81.90	$156.16	$270.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.90 / $100.41 / $135.58	Professional		$81.90	$100.41	$135.58
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $81.90 / $82.86 / $90.57	Facility		$81.90	$82.86	$90.57
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $124.29 / $163.80 / $163.80	Professional		$124.29	$163.80	$163.80
Medica Facility/Professional Facility Modifier Low / Median / High Price $82.86 / $82.86 / $91.63	Facility		$82.86	$82.86	$91.63
Medica Facility/Professional Professional Modifier Low / Median / High Price $82.86 / $92.24 / $350.34	Professional		$82.86	$92.24	$350.34
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 $81.90 / $82.86 / $91.16	Facility		$81.90	$82.86	$91.16
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $124.29 / $163.80 / $163.80	Professional		$124.29	$163.80	$163.80
Quartz Facility/Professional Professional Modifier Low / Median / High Price $81.90 / $105.30 / $269.50	Professional		$81.90	$105.30	$269.50
Quartz Facility/Professional Facility Modifier Low / Median / High Price $81.90 / $81.90 / $394.30	Facility		$81.90	$81.90	$394.30
Quartz Facility/Professional Professional Modifier Low / Median / High Price $81.90 / $145.97 / $350.34	Professional		$81.90	$145.97	$350.34
Security Health Facility/Professional Professional Modifier Low / Median / High Price $114.99 / $114.99 / $114.99	Professional		$114.99	$114.99	$114.99
United Facility/Professional Professional Modifier Low / Median / High Price $81.90 / $86.81 / $104.39	Professional		$81.90	$86.81	$104.39