Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $49.35 / $56.75 / $56.75	Facility		$49.35	$56.75	$56.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.35 / $58.75 / $67.98	Professional		$49.35	$58.75	$67.98
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $97.83 / $107.61 / $178.05	Facility		$97.83	$107.61	$178.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $84.61 / $90.98 / $120.33	Professional		$84.61	$90.98	$120.33
CareSource Facility/Professional Facility Modifier Low / Median / High Price $70.38 / $117.40 / $209.36	Facility		$70.38	$117.40	$209.36
CareSource Facility/Professional Professional Modifier Low / Median / High Price $97.83 / $102.72 / $136.96	Professional		$97.83	$102.72	$136.96
Cigna Facility/Professional Facility Modifier Low / Median / High Price $72.18 / $202.62 / $408.67	Facility		$72.18	$202.62	$408.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.69 / $141.56 / $185.16	Professional		$52.69	$141.56	$185.16
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $31.51 / $74.03 / $112.50	Facility		$31.51	$74.03	$112.50
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $56.02 / $97.83 / $130.44	Professional		$56.02	$97.83	$130.44
Medica Facility/Professional Facility Modifier Low / Median / High Price $49.35 / $97.83 / $556.78	Facility		$49.35	$97.83	$556.78
Medica Facility/Professional Professional Modifier Low / Median / High Price $44.32 / $58.06 / $106.53	Professional		$44.32	$58.06	$106.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $65.00 / $106.91	Professional		$50.00	$65.00	$106.91
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $31.51 / $74.03 / $112.50	Facility		$31.51	$74.03	$112.50
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $56.02 / $97.83 / $130.44	Professional		$56.02	$97.83	$130.44
Quartz Facility/Professional Professional Modifier Low / Median / High Price $97.83 / $150.57 / $293.08	Professional		$97.83	$150.57	$293.08
Quartz Facility/Professional Facility Modifier Low / Median / High Price $72.18 / $191.08 / $556.78	Facility		$72.18	$191.08	$556.78
Quartz Facility/Professional Professional Modifier Low / Median / High Price $52.69 / $72.18 / $1,045.80	Professional		$52.69	$72.18	$1,045.80
Security Health Facility/Professional Professional Modifier Low / Median / High Price $97.83 / $97.83 / $97.83	Professional		$97.83	$97.83	$97.83
Security Health Facility/Professional Professional Modifier Low / Median / High Price $78.12 / $97.83 / $97.83	Professional		$78.12	$97.83	$97.83
United Facility/Professional Professional Modifier Low / Median / High Price $38.97 / $54.19 / $93.55	Professional		$38.97	$54.19	$93.55