Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $19.55 / $19.55 / $19.55	Facility		$19.55	$19.55	$19.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.52 / $19.55 / $25.65	Professional		$15.52	$19.55	$25.65
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $33.68 / $33.68 / $55.57	Facility		$33.68	$33.68	$55.57
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $31.32 / $33.68 / $38.39	Professional		$31.32	$33.68	$38.39
CareSource Facility/Professional Facility Modifier Low / Median / High Price $33.68 / $72.08 / $72.08	Facility		$33.68	$72.08	$72.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $90.11 / $105.30 / $139.96	Facility		$90.11	$105.30	$139.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $13.74 / $48.75 / $63.74	Professional		$13.74	$48.75	$63.74
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $19.32 / $27.38 / $33.68	Facility		$19.32	$27.38	$33.68
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $21.38 / $33.68	Professional		$21.38	$21.38	$33.68
Medica Facility/Professional Facility Modifier Low / Median / High Price $19.32 / $27.75 / $35.36	Facility		$19.32	$27.75	$35.36
Medica Facility/Professional Professional Modifier Low / Median / High Price $15.53 / $19.04 / $72.01	Professional		$15.53	$19.04	$72.01
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.55 / $58.40 / $85.00	Professional		$19.55	$58.40	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $19.32 / $27.75 / $33.68	Facility		$19.32	$27.75	$33.68
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $21.38 / $33.68	Professional		$21.38	$21.38	$33.68
Quartz Facility/Professional Professional Modifier Low / Median / High Price $33.68 / $50.52 / $89.00	Professional		$33.68	$50.52	$89.00
Quartz Facility/Professional Facility Modifier Low / Median / High Price $65.78 / $68.37 / $157.62	Facility		$65.78	$68.37	$157.62
Quartz Facility/Professional Professional Modifier Low / Median / High Price $13.74 / $148.01 / $256.19	Professional		$13.74	$148.01	$256.19
Security Health Facility/Professional Professional Modifier Low / Median / High Price $33.68 / $33.68 / $33.68	Professional		$33.68	$33.68	$33.68
Security Health Facility/Professional Professional Modifier Low / Median / High Price $33.68 / $33.68 / $33.68	Professional		$33.68	$33.68	$33.68
United Facility/Professional Professional Modifier Low / Median / High Price $11.20 / $16.80 / $28.00	Professional		$11.20	$16.80	$28.00