Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $76.59 / $148.90 / $171.02	Facility		$76.59	$148.90	$171.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.36 / $76.59 / $102.11	Professional		$74.36	$76.59	$102.11
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $92.95 / $137.57 / $165.82	Facility		$92.95	$137.57	$165.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.36 / $74.36 / $100.38	Professional		$74.36	$74.36	$100.38
CareSource Facility/Professional Facility Modifier Low / Median / High Price $74.36 / $104.10 / $136.29	Facility		$74.36	$104.10	$136.29
CareSource Facility/Professional Professional Modifier Low / Median / High Price $74.36 / $74.45 / $172.41	Professional		$74.36	$74.45	$172.41
Cigna Facility/Professional Facility Modifier Low / Median / High Price $74.36 / $108.09 / $197.73	Facility		$74.36	$108.09	$197.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.36 / $93.47 / $137.91	Professional		$74.36	$93.47	$137.91
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $66.84 / $74.45 / $82.23	Facility		$66.84	$74.45	$82.23
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $111.68 / $148.72 / $148.72	Professional		$111.68	$148.72	$148.72
Medica Facility/Professional Facility Modifier Low / Median / High Price $66.84 / $74.45 / $82.72	Facility		$66.84	$74.45	$82.72
Medica Facility/Professional Professional Modifier Low / Median / High Price $74.45 / $82.88 / $1,209.31	Professional		$74.45	$82.88	$1,209.31
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 $65.43 / $74.45 / $82.23	Facility		$65.43	$74.45	$82.23
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $111.68 / $148.72 / $148.72	Professional		$111.68	$148.72	$148.72
Quartz Facility/Professional Professional Modifier Low / Median / High Price $74.36 / $112.35 / $225.00	Professional		$74.36	$112.35	$225.00
Quartz Facility/Professional Facility Modifier Low / Median / High Price $74.36 / $74.36 / $366.85	Facility		$74.36	$74.36	$366.85
Quartz Facility/Professional Professional Modifier Low / Median / High Price $74.36 / $134.12 / $1,209.31	Professional		$74.36	$134.12	$1,209.31
Security Health Facility/Professional Professional Modifier Low / Median / High Price $72.03 / $104.40 / $110.79	Professional		$72.03	$104.40	$110.79
United Facility/Professional Professional Modifier Low / Median / High Price $74.36 / $78.08 / $90.05	Professional		$74.36	$78.08	$90.05