Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $102.00 / $102.00 / $102.00	Facility		$102.00	$102.00	$102.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.25 / $112.90 / $163.69	Professional		$89.25	$112.90	$163.69
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $202.19 / $222.41 / $367.99	Facility		$202.19	$222.41	$367.99
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $185.98 / $188.04 / $248.69	Professional		$185.98	$188.04	$248.69
CareSource Facility/Professional Facility Modifier Low / Median / High Price $145.46 / $242.63 / $432.69	Facility		$145.46	$242.63	$432.69
CareSource Facility/Professional Professional Modifier Low / Median / High Price $202.19 / $212.30 / $284.68	Professional		$202.19	$212.30	$284.68
Cigna Facility/Professional Facility Modifier Low / Median / High Price $127.07 / $427.79 / $843.94	Facility		$127.07	$427.79	$843.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.76 / $336.74 / $382.66	Professional		$92.76	$336.74	$382.66
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $102.00 / $157.85 / $232.52	Facility		$102.00	$157.85	$232.52
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $194.02 / $202.19 / $242.63	Professional		$194.02	$202.19	$242.63
Medica Facility/Professional Facility Modifier Low / Median / High Price $121.88 / $202.19 / $939.42	Facility		$121.88	$202.19	$939.42
Medica Facility/Professional Professional Modifier Low / Median / High Price $91.12 / $107.65 / $224.88	Professional		$91.12	$107.65	$224.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $62.00 / $85.00	Professional		$50.00	$62.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $102.00 / $161.75 / $232.52	Facility		$102.00	$161.75	$232.52
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $194.02 / $202.19 / $242.63	Professional		$194.02	$202.19	$242.63
Quartz Facility/Professional Professional Modifier Low / Median / High Price $202.19 / $311.14 / $539.99	Professional		$202.19	$311.14	$539.99
Quartz Facility/Professional Facility Modifier Low / Median / High Price $127.07 / $394.90 / $939.42	Facility		$127.07	$394.90	$939.42
Quartz Facility/Professional Professional Modifier Low / Median / High Price $92.76 / $127.07 / $1,006.48	Professional		$92.76	$127.07	$1,006.48
Security Health Facility/Professional Professional Modifier Low / Median / High Price $202.19 / $202.19 / $202.19	Professional		$202.19	$202.19	$202.19
Security Health Facility/Professional Professional Modifier Low / Median / High Price $202.19 / $202.19 / $202.19	Professional		$202.19	$202.19	$202.19
United Facility/Professional Professional Modifier Low / Median / High Price $74.95 / $105.84 / $262.85	Professional		$74.95	$105.84	$262.85