Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $87.11 / $169.06 / $194.14	Facility		$87.11	$169.06	$194.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.57 / $87.11 / $102.44	Professional		$84.57	$87.11	$102.44
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $105.71 / $156.44 / $188.59	Facility		$105.71	$156.44	$188.59
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $84.57 / $84.57 / $114.16	Professional		$84.57	$84.57	$114.16
CareSource Facility/Professional Facility Modifier Low / Median / High Price $135.31 / $152.22 / $155.01	Facility		$135.31	$152.22	$155.01
Cigna Facility/Professional Facility Modifier Low / Median / High Price $84.57 / $173.69 / $396.32	Facility		$84.57	$173.69	$396.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.57 / $141.16 / $193.69	Professional		$84.57	$141.16	$193.69
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $84.53 / $85.42 / $104.54	Facility		$84.53	$85.42	$104.54
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $126.80 / $169.14 / $169.14	Professional		$126.80	$169.14	$169.14
Medica Facility/Professional Facility Modifier Low / Median / High Price $84.53 / $84.53 / $104.54	Facility		$84.53	$84.53	$104.54
Medica Facility/Professional Professional Modifier Low / Median / High Price $84.53 / $94.10 / $518.54	Professional		$84.53	$94.10	$518.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $287.02	Professional		$50.00	$70.00	$287.02
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $84.53 / $85.42 / $104.54	Facility		$84.53	$85.42	$104.54
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $126.80 / $169.14 / $169.14	Professional		$126.80	$169.14	$169.14
Quartz Facility/Professional Professional Modifier Low / Median / High Price $84.57 / $156.02 / $392.26	Professional		$84.57	$156.02	$392.26
Quartz Facility/Professional Facility Modifier Low / Median / High Price $84.57 / $117.63 / $588.15	Facility		$84.57	$117.63	$588.15
Quartz Facility/Professional Professional Modifier Low / Median / High Price $84.57 / $216.06 / $518.54	Professional		$84.57	$216.06	$518.54
Security Health Facility/Professional Professional Modifier Low / Median / High Price $118.74 / $118.74 / $118.74	Professional		$118.74	$118.74	$118.74
United Facility/Professional Professional Modifier Low / Median / High Price $84.57 / $86.26 / $100.64	Professional		$84.57	$86.26	$100.64