Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $138.93 / $138.93 / $138.93	Facility		$138.93	$138.93	$138.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.88 / $138.93 / $148.37	Professional		$134.88	$138.93	$148.37
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.88 / $134.88 / $209.07	Professional		$134.88	$134.88	$209.07
CareSource Facility/Professional Facility Modifier Low / Median / High Price $184.67 / $214.48 / $215.82	Facility		$184.67	$214.48	$215.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $187.38 / $342.79 / $485.85	Facility		$187.38	$342.79	$485.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $134.88 / $173.81 / $257.52	Professional		$134.88	$173.81	$257.52
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $134.88 / $138.93 / $212.56	Facility		$134.88	$138.93	$212.56
Medica Facility/Professional Facility Modifier Low / Median / High Price $137.19 / $141.31 / $216.20	Facility		$137.19	$141.31	$216.20
Medica Facility/Professional Professional Modifier Low / Median / High Price $137.19 / $137.19 / $288.10	Professional		$137.19	$137.19	$288.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $85.00	Professional		$50.00	$70.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $134.88 / $138.93 / $212.56	Facility		$134.88	$138.93	$212.56
Quartz Facility/Professional Professional Modifier Low / Median / High Price $134.88 / $163.91 / $444.64	Professional		$134.88	$163.91	$444.64
Quartz Facility/Professional Facility Modifier Low / Median / High Price $136.47 / $181.54 / $633.20	Facility		$136.47	$181.54	$633.20
Quartz Facility/Professional Professional Modifier Low / Median / High Price $134.88 / $202.95 / $633.20	Professional		$134.88	$202.95	$633.20
Security Health Facility/Professional Professional Modifier Low / Median / High Price $189.39 / $189.39 / $189.39	Professional		$189.39	$189.39	$189.39
United Facility/Professional Professional Modifier Low / Median / High Price $134.88 / $134.88 / $175.36	Professional		$134.88	$134.88	$175.36