Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $69.55 / $69.55 / $69.55	Facility		$69.55	$69.55	$69.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.46 / $69.55 / $115.47	Professional		$56.46	$69.55	$115.47
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $137.86 / $151.65 / $250.91	Facility		$137.86	$151.65	$250.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $119.23 / $128.21 / $169.56	Professional		$119.23	$128.21	$169.56
CareSource Facility/Professional Facility Modifier Low / Median / High Price $99.18 / $295.02 / $295.02	Facility		$99.18	$295.02	$295.02
Cigna Facility/Professional Facility Modifier Low / Median / High Price $89.19 / $285.18 / $575.22	Facility		$89.19	$285.18	$575.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $65.11 / $199.69 / $260.91	Professional		$65.11	$199.69	$260.91
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $39.04 / $104.33 / $158.54	Facility		$39.04	$104.33	$158.54
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $78.94 / $137.86 / $165.43	Professional		$78.94	$137.86	$165.43
Medica Facility/Professional Facility Modifier Low / Median / High Price $67.58 / $137.86 / $645.28	Facility		$67.58	$137.86	$645.28
Medica Facility/Professional Professional Modifier Low / Median / High Price $61.28 / $91.08 / $151.16	Professional		$61.28	$91.08	$151.16
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $61.17 / $85.00	Professional		$50.00	$61.17	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $39.04 / $104.33 / $158.54	Facility		$39.04	$104.33	$158.54
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $78.94 / $137.86 / $165.43	Professional		$78.94	$137.86	$165.43
Quartz Facility/Professional Professional Modifier Low / Median / High Price $137.86 / $212.19 / $362.34	Professional		$137.86	$212.19	$362.34
Quartz Facility/Professional Facility Modifier Low / Median / High Price $89.19 / $269.26 / $645.28	Facility		$89.19	$269.26	$645.28
Quartz Facility/Professional Professional Modifier Low / Median / High Price $65.11 / $89.19 / $799.97	Professional		$65.11	$89.19	$799.97
Security Health Facility/Professional Professional Modifier Low / Median / High Price $137.86 / $137.86 / $137.86	Professional		$137.86	$137.86	$137.86
Security Health Facility/Professional Professional Modifier Low / Median / High Price $137.86 / $137.86 / $137.86	Professional		$137.86	$137.86	$137.86
United Facility/Professional Professional Modifier Low / Median / High Price $47.34 / $80.62 / $118.25	Professional		$47.34	$80.62	$118.25