Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $120.59 / $293.30 / $615.61	Facility		$120.59	$293.30	$615.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.59 / $133.57 / $415.34	Professional		$120.59	$133.57	$415.34
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $239.05 / $262.95 / $435.07	Facility		$239.05	$262.95	$435.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $200.08 / $222.32 / $294.02	Professional		$200.08	$222.32	$294.02
CareSource Facility/Professional Facility Modifier Low / Median / High Price $171.97 / $286.86 / $511.57	Facility		$171.97	$286.86	$511.57
CareSource Facility/Professional Professional Modifier Low / Median / High Price $239.05 / $251.00 / $336.48	Professional		$239.05	$251.00	$336.48
Cigna Facility/Professional Facility Modifier Low / Median / High Price $152.55 / $527.98 / $997.89	Facility		$152.55	$527.98	$997.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.36 / $346.41 / $452.43	Professional		$111.36	$346.41	$452.43
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $68.78 / $180.89 / $274.91	Facility		$68.78	$180.89	$274.91
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $136.87 / $233.30 / $286.86	Professional		$136.87	$233.30	$286.86
Medica Facility/Professional Facility Modifier Low / Median / High Price $119.06 / $239.05 / $1,113.14	Facility		$119.06	$239.05	$1,113.14
Medica Facility/Professional Professional Modifier Low / Median / High Price $105.58 / $126.72 / $260.29	Professional		$105.58	$126.72	$260.29
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $65.00 / $91.74	Professional		$50.00	$65.00	$91.74
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $68.78 / $180.89 / $274.91	Facility		$68.78	$180.89	$274.91
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $136.87 / $233.30 / $286.86	Professional		$136.87	$233.30	$286.86
Quartz Facility/Professional Professional Modifier Low / Median / High Price $239.05 / $367.89 / $639.36	Professional		$239.05	$367.89	$639.36
Quartz Facility/Professional Facility Modifier Low / Median / High Price $152.55 / $466.90 / $1,113.14	Facility		$152.55	$466.90	$1,113.14
Quartz Facility/Professional Professional Modifier Low / Median / High Price $111.36 / $152.55 / $1,203.42	Professional		$111.36	$152.55	$1,203.42
Security Health Facility/Professional Professional Modifier Low / Median / High Price $239.05 / $239.05 / $239.05	Professional		$239.05	$239.05	$239.05
Security Health Facility/Professional Professional Modifier Low / Median / High Price $190.87 / $239.05 / $239.05	Professional		$190.87	$239.05	$239.05
United Facility/Professional Professional Modifier Low / Median / High Price $88.78 / $119.26 / $227.78	Professional		$88.78	$119.26	$227.78