Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $57.43 / $57.43 / $57.43	Facility		$57.43	$57.43	$57.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.68 / $57.43 / $96.21	Professional		$47.68	$57.43	$96.21
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $113.85 / $125.24 / $207.21	Facility		$113.85	$125.24	$207.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $101.42 / $105.88 / $140.03	Professional		$101.42	$105.88	$140.03
CareSource Facility/Professional Facility Modifier Low / Median / High Price $81.90 / $243.64 / $243.64	Facility		$81.90	$243.64	$243.64
Cigna Facility/Professional Facility Modifier Low / Median / High Price $90.38 / $251.45 / $475.85	Facility		$90.38	$251.45	$475.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $76.81 / $167.64 / $215.46	Professional		$76.81	$167.64	$215.46
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $32.76 / $86.15 / $130.93	Facility		$32.76	$86.15	$130.93
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $65.19 / $111.09 / $136.62	Professional		$65.19	$111.09	$136.62
Medica Facility/Professional Facility Modifier Low / Median / High Price $56.70 / $113.85 / $532.02	Facility		$56.70	$113.85	$532.02
Medica Facility/Professional Professional Modifier Low / Median / High Price $51.99 / $76.08 / $123.96	Professional		$51.99	$76.08	$123.96
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 $32.76 / $86.15 / $130.93	Facility		$32.76	$86.15	$130.93
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $65.19 / $111.09 / $136.62	Professional		$65.19	$111.09	$136.62
Quartz Facility/Professional Professional Modifier Low / Median / High Price $113.85 / $175.20 / $304.12	Professional		$113.85	$175.20	$304.12
Quartz Facility/Professional Facility Modifier Low / Median / High Price $90.38 / $222.36 / $532.02	Facility		$90.38	$222.36	$532.02
Quartz Facility/Professional Professional Modifier Low / Median / High Price $76.81 / $90.38 / $573.15	Professional		$76.81	$90.38	$573.15
Security Health Facility/Professional Professional Modifier Low / Median / High Price $113.85 / $113.85 / $113.85	Professional		$113.85	$113.85	$113.85
Security Health Facility/Professional Professional Modifier Low / Median / High Price $113.85 / $113.85 / $113.85	Professional		$113.85	$113.85	$113.85
United Facility/Professional Professional Modifier Low / Median / High Price $45.36 / $68.31 / $123.96	Professional		$45.36	$68.31	$123.96