Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.43 / $53.43 / $93.03	Facility		$53.43	$53.43	$93.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.30 / $60.04 / $142.60	Professional		$53.30	$60.04	$142.60
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $105.92 / $116.51 / $192.77	Facility		$105.92	$116.51	$192.77
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $98.51 / $98.51 / $130.28	Professional		$98.51	$98.51	$130.28
CareSource Facility/Professional Facility Modifier Low / Median / High Price $76.20 / $116.51 / $226.67	Facility		$76.20	$116.51	$226.67
CareSource Facility/Professional Professional Modifier Low / Median / High Price $105.92 / $111.22 / $134.26	Professional		$105.92	$111.22	$134.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $61.21 / $223.41 / $442.26	Facility		$61.21	$223.41	$442.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.68 / $155.72 / $200.46	Professional		$44.68	$155.72	$200.46
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $53.43 / $80.15 / $121.81	Facility		$53.43	$80.15	$121.81
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $95.90 / $105.92 / $127.10	Professional		$95.90	$105.92	$127.10
Medica Facility/Professional Facility Modifier Low / Median / High Price $65.54 / $105.92 / $474.60	Facility		$65.54	$105.92	$474.60
Medica Facility/Professional Professional Modifier Low / Median / High Price $47.63 / $56.91 / $115.34	Professional		$47.63	$56.91	$115.34
Molina Facility/Professional Professional Modifier Low / Median / High Price $22.76 / $55.00 / $85.00	Professional		$22.76	$55.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $53.43 / $81.75 / $121.81	Facility		$53.43	$81.75	$121.81
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $95.90 / $105.92 / $127.10	Professional		$95.90	$105.92	$127.10
Quartz Facility/Professional Professional Modifier Low / Median / High Price $105.92 / $163.01 / $287.06	Professional		$105.92	$163.01	$287.06
Quartz Facility/Professional Facility Modifier Low / Median / High Price $61.21 / $206.88 / $474.60	Facility		$61.21	$206.88	$474.60
Quartz Facility/Professional Professional Modifier Low / Median / High Price $44.68 / $61.21 / $521.73	Professional		$44.68	$61.21	$521.73
Security Health Facility/Professional Professional Modifier Low / Median / High Price $105.92 / $105.92 / $105.92	Professional		$105.92	$105.92	$105.92
Security Health Facility/Professional Professional Modifier Low / Median / High Price $105.92 / $105.92 / $105.92	Professional		$105.92	$105.92	$105.92
United Facility/Professional Facility Modifier Low / Median / High Price $153.43 / $153.43 / $153.43	Facility		$153.43	$153.43	$153.43
United Facility/Professional Professional Modifier Low / Median / High Price $39.86 / $52.84 / $93.91	Professional		$39.86	$52.84	$93.91