Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $18.77 / $18.77 / $18.77	Facility		$18.77	$18.77	$18.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.23 / $18.77 / $33.43	Professional		$15.23	$18.77	$33.43
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $85.14 / $102.96 / $108.90	Facility		$85.14	$102.96	$108.90
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $24.04 / $25.00 / $35.70	Professional		$24.04	$25.00	$35.70
CareSource Facility/Professional Facility Modifier Low / Median / High Price $27.93 / $84.74 / $84.74	Facility		$27.93	$84.74	$84.74
Cigna Facility/Professional Facility Modifier Low / Median / High Price $22.22 / $72.98 / $113.36	Facility		$22.22	$72.98	$113.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $16.22 / $27.38 / $34.22	Professional		$16.22	$27.38	$34.22
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $17.38 / $31.68 / $45.54	Facility		$17.38	$31.68	$45.54
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $39.60 / $47.52 / $55.81	Professional		$39.60	$47.52	$55.81
Medica Facility/Professional Facility Modifier Low / Median / High Price $18.77 / $39.60 / $215.96	Facility		$18.77	$39.60	$215.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $17.35 / $25.32 / $42.71	Professional		$17.35	$25.32	$42.71
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 $17.38 / $28.72 / $45.54	Facility		$17.38	$28.72	$45.54
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $39.60 / $47.52 / $55.81	Professional		$39.60	$47.52	$55.81
Quartz Facility/Professional Professional Modifier Low / Median / High Price $39.60 / $73.20 / $122.45	Professional		$39.60	$73.20	$122.45
Quartz Facility/Professional Facility Modifier Low / Median / High Price $22.22 / $74.54 / $215.96	Facility		$22.22	$74.54	$215.96
Quartz Facility/Professional Professional Modifier Low / Median / High Price $16.22 / $22.22 / $214.83	Professional		$16.22	$22.22	$214.83
Security Health Facility/Professional Professional Modifier Low / Median / High Price $39.60 / $39.60 / $39.60	Professional		$39.60	$39.60	$39.60
Security Health Facility/Professional Professional Modifier Low / Median / High Price $39.60 / $39.60 / $39.60	Professional		$39.60	$39.60	$39.60
United Facility/Professional Professional Modifier Low / Median / High Price $15.38 / $25.32 / $32.86	Professional		$15.38	$25.32	$32.86