Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $561.60 / $702.00 / $1,043.64	Facility		$561.60	$702.00	$1,043.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $360.36 / $561.60 / $1,500.00	Professional		$360.36	$561.60	$1,500.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,006.20 / $1,216.80 / $1,287.00	Facility		$1,006.20	$1,216.80	$1,287.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $187.20 / $187.20 / $2,004.54	Professional		$187.20	$187.20	$2,004.54
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,143.75 / $1,143.75 / $1,188.72	Facility		$1,143.75	$1,143.75	$1,188.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,287.70 / $1,504.78 / $2,308.37	Facility		$1,287.70	$1,504.78	$2,308.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $537.73 / $1,260.23 / $1,432.08	Professional		$537.73	$1,260.23	$1,432.08
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $360.36 / $561.60 / $1,638.00	Facility		$360.36	$561.60	$1,638.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $421.20 / $561.60 / $1,638.00	Facility		$421.20	$561.60	$1,638.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $234.00 / $280.80 / $1,443.24	Professional		$234.00	$280.80	$1,443.24
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $468.00	Professional		$50.00	$70.00	$468.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $360.36 / $561.60 / $1,638.00	Facility		$360.36	$561.60	$1,638.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $841.00 / $1,116.07 / $1,565.36	Professional		$841.00	$1,116.07	$1,565.36
Quartz Facility/Professional Facility Modifier Low / Median / High Price $936.00 / $2,223.00 / $2,223.00	Facility		$936.00	$2,223.00	$2,223.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $431.49 / $2,340.00 / $2,340.00	Professional		$431.49	$2,340.00	$2,340.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $468.00 / $468.00 / $996.63	Professional		$468.00	$468.00	$996.63
Security Health Facility/Professional Professional Modifier Low / Median / High Price $468.00 / $1,156.01 / $2,555.28	Professional		$468.00	$1,156.01	$2,555.28
United Facility/Professional Professional Modifier Low / Median / High Price $203.44 / $280.80 / $982.80	Professional		$203.44	$280.80	$982.80