Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $69.45 / $69.45 / $69.45	Facility		$69.45	$69.45	$69.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.04 / $69.45 / $95.67	Professional		$49.04	$69.45	$95.67
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $137.68 / $151.44 / $250.58	Facility		$137.68	$151.44	$250.58
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $119.07 / $128.04 / $169.34	Professional		$119.07	$128.04	$169.34
CareSource Facility/Professional Facility Modifier Low / Median / High Price $99.04 / $294.64 / $294.64	Facility		$99.04	$294.64	$294.64
Cigna Facility/Professional Facility Modifier Low / Median / High Price $64.52 / $284.23 / $575.22	Facility		$64.52	$284.23	$575.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.10 / $199.69 / $260.56	Professional		$47.10	$199.69	$260.56
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $33.26 / $104.19 / $158.33	Facility		$33.26	$104.19	$158.33
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $78.83 / $120.42 / $165.22	Professional		$78.83	$120.42	$165.22
Medica Facility/Professional Facility Modifier Low / Median / High Price $57.57 / $137.68 / $554.66	Facility		$57.57	$137.68	$554.66
Medica Facility/Professional Professional Modifier Low / Median / High Price $51.52 / $68.69 / $149.91	Professional		$51.52	$68.69	$149.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $65.00 / $85.00	Professional		$50.00	$65.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $33.26 / $104.19 / $158.33	Facility		$33.26	$104.19	$158.33
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $78.83 / $120.42 / $165.22	Professional		$78.83	$120.42	$165.22
Quartz Facility/Professional Professional Modifier Low / Median / High Price $137.68 / $206.52 / $309.14	Professional		$137.68	$206.52	$309.14
Quartz Facility/Professional Facility Modifier Low / Median / High Price $64.52 / $268.89 / $554.66	Facility		$64.52	$268.89	$554.66
Quartz Facility/Professional Professional Modifier Low / Median / High Price $47.10 / $64.52 / $639.69	Professional		$47.10	$64.52	$639.69
Security Health Facility/Professional Professional Modifier Low / Median / High Price $137.68 / $137.68 / $137.68	Professional		$137.68	$137.68	$137.68
Security Health Facility/Professional Professional Modifier Low / Median / High Price $137.68 / $137.68 / $137.68	Professional		$137.68	$137.68	$137.68
United Facility/Professional Professional Modifier Low / Median / High Price $45.79 / $68.69 / $131.65	Professional		$45.79	$68.69	$131.65