Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $55.17 / $55.17 / $55.17	Facility		$55.17	$55.17	$55.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.35 / $55.17 / $72.34	Professional		$30.35	$55.17	$72.34
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $95.02 / $95.02 / $156.78	Facility		$95.02	$95.02	$156.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $88.37 / $95.02 / $108.32	Professional		$88.37	$95.02	$108.32
CareSource Facility/Professional Facility Modifier Low / Median / High Price $95.02 / $203.34 / $203.34	Facility		$95.02	$203.34	$203.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $255.02 / $298.01 / $396.08	Facility		$255.02	$298.01	$396.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.77 / $137.81 / $179.83	Professional		$38.77	$137.81	$179.83
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $53.36 / $78.30 / $159.30	Facility		$53.36	$78.30	$159.30
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $52.91 / $52.91 / $95.02	Professional		$52.91	$52.91	$95.02
Medica Facility/Professional Facility Modifier Low / Median / High Price $54.51 / $78.30 / $178.61	Facility		$54.51	$78.30	$178.61
Medica Facility/Professional Professional Modifier Low / Median / High Price $43.83 / $52.25 / $120.39	Professional		$43.83	$52.25	$120.39
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $58.50 / $85.00	Professional		$50.00	$58.50	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $53.36 / $78.30 / $159.30	Facility		$53.36	$78.30	$159.30
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $52.91 / $52.91 / $95.02	Professional		$52.91	$52.91	$95.02
Quartz Facility/Professional Professional Modifier Low / Median / High Price $95.02 / $142.53 / $250.00	Professional		$95.02	$142.53	$250.00
Quartz Facility/Professional Facility Modifier Low / Median / High Price $185.58 / $192.89 / $444.69	Facility		$185.58	$192.89	$444.69
Quartz Facility/Professional Professional Modifier Low / Median / High Price $38.77 / $417.56 / $637.82	Professional		$38.77	$417.56	$637.82
Security Health Facility/Professional Professional Modifier Low / Median / High Price $95.02 / $95.02 / $95.02	Professional		$95.02	$95.02	$95.02
Security Health Facility/Professional Professional Modifier Low / Median / High Price $94.64 / $95.02 / $95.02	Professional		$94.64	$95.02	$95.02
United Facility/Professional Professional Modifier Low / Median / High Price $39.94 / $47.40 / $88.54	Professional		$39.94	$47.40	$88.54