Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $47.50 / $47.50 / $47.50	Facility		$47.50	$47.50	$47.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.72 / $47.50 / $84.92	Professional		$44.72	$47.50	$84.92
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $94.16 / $103.58 / $171.37	Facility		$94.16	$103.58	$171.37
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $84.74 / $87.57 / $115.81	Professional		$84.74	$87.57	$115.81
CareSource Facility/Professional Facility Modifier Low / Median / High Price $67.73 / $201.50 / $201.50	Facility		$67.73	$201.50	$201.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $58.84 / $195.12 / $393.28	Facility		$58.84	$195.12	$393.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.95 / $136.41 / $178.20	Professional		$42.95	$136.41	$178.20
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $30.33 / $71.25 / $108.28	Facility		$30.33	$71.25	$108.28
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $53.92 / $94.16 / $112.99	Professional		$53.92	$94.16	$112.99
Medica Facility/Professional Facility Modifier Low / Median / High Price $47.50 / $94.16 / $476.85	Facility		$47.50	$94.16	$476.85
Medica Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $54.81 / $102.53	Professional		$42.66	$54.81	$102.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.89 / $55.00 / $85.00	Professional		$19.89	$55.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $30.33 / $71.25 / $108.28	Facility		$30.33	$71.25	$108.28
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $53.92 / $94.16 / $112.99	Professional		$53.92	$94.16	$112.99
Quartz Facility/Professional Professional Modifier Low / Median / High Price $94.16 / $144.91 / $282.04	Professional		$94.16	$144.91	$282.04
Quartz Facility/Professional Facility Modifier Low / Median / High Price $58.84 / $183.90 / $476.85	Facility		$58.84	$183.90	$476.85
Quartz Facility/Professional Professional Modifier Low / Median / High Price $42.95 / $58.84 / $612.91	Professional		$42.95	$58.84	$612.91
Security Health Facility/Professional Professional Modifier Low / Median / High Price $94.16 / $94.16 / $94.16	Professional		$94.16	$94.16	$94.16
Security Health Facility/Professional Professional Modifier Low / Median / High Price $94.16 / $94.16 / $94.16	Professional		$94.16	$94.16	$94.16
United Facility/Professional Professional Modifier Low / Median / High Price $37.52 / $54.29 / $94.16	Professional		$37.52	$54.29	$94.16