Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $57.87 / $57.87 / $57.87	Facility		$57.87	$57.87	$57.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.87 / $63.32 / $115.06	Professional		$57.87	$63.32	$115.06
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $97.41 / $107.15 / $177.29	Facility		$97.41	$107.15	$177.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $90.59 / $90.59 / $119.81	Professional		$90.59	$90.59	$119.81
CareSource Facility/Professional Facility Modifier Low / Median / High Price $115.64 / $208.46 / $208.46	Facility		$115.64	$208.46	$208.46
Cigna Facility/Professional Facility Modifier Low / Median / High Price $76.68 / $332.08 / $403.03	Facility		$76.68	$332.08	$403.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $55.98 / $141.44 / $183.28	Professional		$55.98	$141.44	$183.28
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $46.25 / $86.81 / $116.89	Facility		$46.25	$86.81	$116.89
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $86.99 / $92.03 / $116.89	Professional		$86.99	$92.03	$116.89
Medica Facility/Professional Facility Modifier Low / Median / High Price $57.87 / $112.02 / $469.03	Facility		$57.87	$112.02	$469.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $70.20 / $83.59 / $137.87	Professional		$70.20	$83.59	$137.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $65.00 / $87.70	Professional		$50.00	$65.00	$87.70
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $46.25 / $95.25 / $116.89	Facility		$46.25	$95.25	$116.89
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $86.99 / $92.03 / $116.89	Professional		$86.99	$92.03	$116.89
Quartz Facility/Professional Professional Modifier Low / Median / High Price $97.41 / $198.66 / $258.95	Professional		$97.41	$198.66	$258.95
Quartz Facility/Professional Facility Modifier Low / Median / High Price $76.68 / $189.14 / $469.03	Facility		$76.68	$189.14	$469.03
Quartz Facility/Professional Professional Modifier Low / Median / High Price $55.98 / $76.68 / $668.30	Professional		$55.98	$76.68	$668.30
Security Health Facility/Professional Professional Modifier Low / Median / High Price $133.54 / $133.54 / $133.54	Professional		$133.54	$133.54	$133.54
Security Health Facility/Professional Professional Modifier Low / Median / High Price $128.34 / $133.54 / $150.99	Professional		$128.34	$133.54	$150.99
United Facility/Professional Facility Modifier Low / Median / High Price $0.11 / $71.01 / $79.54	Facility		$0.11	$71.01	$79.54
United Facility/Professional Professional Modifier Low / Median / High Price $59.71 / $80.20 / $133.66	Professional		$59.71	$80.20	$133.66