Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $75.98 / $75.98 / $75.98	Facility		$75.98	$75.98	$75.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.93 / $75.98 / $126.17	Professional		$48.93	$75.98	$126.17
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $150.63 / $165.70 / $274.16	Facility		$150.63	$165.70	$274.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $135.57 / $140.10 / $185.28	Professional		$135.57	$140.10	$185.28
CareSource Facility/Professional Facility Modifier Low / Median / High Price $108.37 / $322.37 / $322.37	Facility		$108.37	$322.37	$322.37
Cigna Facility/Professional Facility Modifier Low / Median / High Price $97.44 / $311.44 / $628.40	Facility		$97.44	$311.44	$628.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.13 / $218.44 / $285.10	Professional		$71.13	$218.44	$285.10
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $37.83 / $113.99 / $173.24	Facility		$37.83	$113.99	$173.24
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $86.25 / $150.63 / $180.77	Professional		$86.25	$150.63	$180.77
Medica Facility/Professional Facility Modifier Low / Median / High Price $65.48 / $150.63 / $629.92	Facility		$65.48	$150.63	$629.92
Medica Facility/Professional Professional Modifier Low / Median / High Price $60.01 / $88.28 / $164.03	Professional		$60.01	$88.28	$164.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $65.00 / $85.00	Professional		$50.00	$65.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $37.83 / $113.99 / $173.24	Facility		$37.83	$113.99	$173.24
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $86.25 / $150.63 / $180.77	Professional		$86.25	$150.63	$180.77
Quartz Facility/Professional Professional Modifier Low / Median / High Price $150.63 / $225.96 / $351.30	Professional		$150.63	$225.96	$351.30
Quartz Facility/Professional Facility Modifier Low / Median / High Price $97.44 / $294.22 / $629.92	Facility		$97.44	$294.22	$629.92
Quartz Facility/Professional Professional Modifier Low / Median / High Price $71.13 / $97.44 / $751.68	Professional		$71.13	$97.44	$751.68
Security Health Facility/Professional Professional Modifier Low / Median / High Price $150.63 / $150.63 / $150.63	Professional		$150.63	$150.63	$150.63
Security Health Facility/Professional Professional Modifier Low / Median / High Price $150.63 / $150.63 / $150.63	Professional		$150.63	$150.63	$150.63
United Facility/Professional Facility Modifier Low / Median / High Price $187.92 / $187.92 / $187.92	Facility		$187.92	$187.92	$187.92
United Facility/Professional Professional Modifier Low / Median / High Price $50.10 / $75.15 / $129.19	Professional		$50.10	$75.15	$129.19