Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $357.20 / $357.20 / $357.20	Professional		$357.20	$357.20	$357.20
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $817.00 / $988.00 / $1,045.00	Facility		$817.00	$988.00	$1,045.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $456.00 / $1,246.40 / $1,627.62	Professional		$456.00	$1,246.40	$1,627.62
CareSource Facility/Professional Facility Modifier Low / Median / High Price $578.33 / $578.33 / $578.33	Facility		$578.33	$578.33	$578.33
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,046.20 / $1,222.57 / $1,875.45	Facility		$1,046.20	$1,222.57	$1,875.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $450.06 / $1,023.26 / $1,162.80	Professional		$450.06	$1,023.26	$1,162.80
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $292.60 / $456.00 / $1,330.00	Facility		$292.60	$456.00	$1,330.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $292.60 / $456.00 / $1,330.00	Facility		$292.60	$456.00	$1,330.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $190.00 / $228.00 / $1,171.85	Professional		$190.00	$228.00	$1,171.85
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 $292.60 / $456.00 / $1,330.00	Facility		$292.60	$456.00	$1,330.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $634.50 / $906.28 / $1,271.11	Professional		$634.50	$906.28	$1,271.11
Quartz Facility/Professional Facility Modifier Low / Median / High Price $760.00 / $1,805.00 / $1,805.00	Facility		$760.00	$1,805.00	$1,805.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,520.00 / $1,900.00 / $1,900.00	Professional		$1,520.00	$1,900.00	$1,900.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $809.23 / $809.23 / $809.23	Professional		$809.23	$809.23	$809.23
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,104.35 / $2,074.80 / $2,074.80	Professional		$1,104.35	$2,074.80	$2,074.80
United Facility/Professional Facility Modifier Low / Median / High Price $304.00 / $304.00 / $824.60	Facility		$304.00	$304.00	$824.60
United Facility/Professional Professional Modifier Low / Median / High Price $159.60 / $228.00 / $707.33	Professional		$159.60	$228.00	$707.33