Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.65 / $63.65 / $142.77	Facility		$63.65	$63.65	$142.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.79 / $63.65 / $235.95	Professional		$61.79	$63.65	$235.95
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $114.33 / $132.87 / $137.81	Facility		$114.33	$132.87	$137.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $61.80 / $61.80 / $83.43	Professional		$61.80	$61.80	$83.43
CareSource Facility/Professional Facility Modifier Low / Median / High Price $84.61 / $84.61 / $98.88	Facility		$84.61	$84.61	$98.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $61.80 / $414.67 / $592.75	Facility		$61.80	$414.67	$592.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.19 / $292.44 / $332.31	Professional		$87.19	$292.44	$332.31
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $61.80 / $62.15 / $136.16	Facility		$61.80	$62.15	$136.16
Medica Facility/Professional Facility Modifier Low / Median / High Price $62.15 / $62.15 / $136.87	Facility		$62.15	$62.15	$136.87
Medica Facility/Professional Professional Modifier Low / Median / High Price $62.15 / $62.15 / $93.23	Professional		$62.15	$62.15	$93.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $85.00 / $85.57 / $208.79	Professional		$85.00	$85.57	$208.79
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $61.80 / $62.15 / $136.16	Facility		$61.80	$62.15	$136.16
Quartz Facility/Professional Professional Modifier Low / Median / High Price $58.60 / $188.12 / $575.29	Professional		$58.60	$188.12	$575.29
Quartz Facility/Professional Facility Modifier Low / Median / High Price $747.02 / $747.02 / $747.02	Facility		$747.02	$747.02	$747.02
Quartz Facility/Professional Professional Modifier Low / Median / High Price $61.80 / $61.80 / $61.80	Professional		$61.80	$61.80	$61.80
Security Health Facility/Professional Professional Modifier Low / Median / High Price $86.77 / $86.77 / $86.77	Professional		$86.77	$86.77	$86.77
United Facility/Professional Professional Modifier Low / Median / High Price $61.80 / $61.80 / $98.88	Professional		$61.80	$61.80	$98.88