Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $85.56 / $85.56 / $85.56	Facility		$85.56	$85.56	$85.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.90 / $85.56 / $112.22	Professional		$67.90	$85.56	$112.22
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $147.37 / $147.37 / $243.16	Facility		$147.37	$147.37	$243.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $137.05 / $147.37 / $168.00	Professional		$137.05	$147.37	$168.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $147.37 / $315.37 / $315.37	Facility		$147.37	$315.37	$315.37
Cigna Facility/Professional Facility Modifier Low / Median / High Price $396.49 / $463.33 / $615.80	Facility		$396.49	$463.33	$615.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.12 / $213.75 / $278.91	Professional		$60.12	$213.75	$278.91
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $84.55 / $121.44 / $147.37	Facility		$84.55	$121.44	$147.37
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $107.69 / $107.69 / $147.37	Professional		$107.69	$107.69	$147.37
Medica Facility/Professional Facility Modifier Low / Median / High Price $84.55 / $121.44 / $154.74	Facility		$84.55	$121.44	$154.74
Medica Facility/Professional Professional Modifier Low / Median / High Price $67.98 / $83.32 / $364.10	Professional		$67.98	$83.32	$364.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $85.62	Professional		$50.00	$70.00	$85.62
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $84.55 / $121.44 / $147.37	Facility		$84.55	$121.44	$147.37
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $107.69 / $107.69 / $147.37	Professional		$107.69	$107.69	$147.37
Quartz Facility/Professional Professional Modifier Low / Median / High Price $147.37 / $221.06 / $387.00	Professional		$147.37	$221.06	$387.00
Quartz Facility/Professional Facility Modifier Low / Median / High Price $287.83 / $299.16 / $689.69	Facility		$287.83	$299.16	$689.69
Quartz Facility/Professional Professional Modifier Low / Median / High Price $60.12 / $647.64 / $1,295.07	Professional		$60.12	$647.64	$1,295.07
Security Health Facility/Professional Professional Modifier Low / Median / High Price $147.37 / $147.37 / $147.37	Professional		$147.37	$147.37	$147.37
Security Health Facility/Professional Professional Modifier Low / Median / High Price $147.37 / $147.37 / $147.37	Professional		$147.37	$147.37	$147.37
United Facility/Professional Professional Modifier Low / Median / High Price $52.08 / $73.52 / $122.53	Professional		$52.08	$73.52	$122.53