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 $44.75 / $57.87 / $84.99	Professional		$44.75	$57.87	$84.99
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $114.72 / $126.19 / $208.79	Facility		$114.72	$126.19	$208.79
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $103.24 / $106.69 / $141.10	Professional		$103.24	$106.69	$141.10
CareSource Facility/Professional Facility Modifier Low / Median / High Price $82.53 / $245.50 / $245.50	Facility		$82.53	$245.50	$245.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $81.37 / $237.35 / $478.65	Facility		$81.37	$237.35	$478.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $59.40 / $166.41 / $217.11	Professional		$59.40	$166.41	$217.11
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $30.34 / $86.81 / $131.93	Facility		$30.34	$86.81	$131.93
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $65.67 / $114.72 / $137.66	Professional		$65.67	$114.72	$137.66
Medica Facility/Professional Facility Modifier Low / Median / High Price $52.53 / $114.72 / $494.49	Facility		$52.53	$114.72	$494.49
Medica Facility/Professional Professional Modifier Low / Median / High Price $45.70 / $57.23 / $124.91	Professional		$45.70	$57.23	$124.91
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 $30.34 / $86.81 / $131.93	Facility		$30.34	$86.81	$131.93
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $65.67 / $114.72 / $137.66	Professional		$65.67	$114.72	$137.66
Quartz Facility/Professional Professional Modifier Low / Median / High Price $114.72 / $176.56 / $282.04	Professional		$114.72	$176.56	$282.04
Quartz Facility/Professional Facility Modifier Low / Median / High Price $81.37 / $224.06 / $494.49	Facility		$81.37	$224.06	$494.49
Quartz Facility/Professional Professional Modifier Low / Median / High Price $59.40 / $81.37 / $884.34	Professional		$59.40	$81.37	$884.34
Security Health Facility/Professional Professional Modifier Low / Median / High Price $114.72 / $114.72 / $114.72	Professional		$114.72	$114.72	$114.72
Security Health Facility/Professional Professional Modifier Low / Median / High Price $114.72 / $114.72 / $114.72	Professional		$114.72	$114.72	$114.72
United Facility/Professional Professional Modifier Low / Median / High Price $39.18 / $57.23 / $109.70	Professional		$39.18	$57.23	$109.70