Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $528.00 / $660.00 / $981.20	Facility		$528.00	$660.00	$981.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.80 / $418.00 / $660.00	Professional		$338.80	$418.00	$660.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $946.00 / $1,144.00 / $1,210.00	Facility		$946.00	$1,144.00	$1,210.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $176.00 / $176.26 / $1,760.00	Professional		$176.00	$176.26	$1,760.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,117.59 / $1,164.93 / $1,164.93	Facility		$1,117.59	$1,164.93	$1,164.93
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,211.10 / $1,415.27 / $2,171.06	Facility		$1,211.10	$1,415.27	$2,171.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $505.51 / $1,184.83 / $1,346.40	Professional		$505.51	$1,184.83	$1,346.40
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $338.80 / $528.00 / $1,540.00	Facility		$338.80	$528.00	$1,540.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $396.00 / $528.00 / $1,540.00	Facility		$396.00	$528.00	$1,540.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $105.76 / $264.00 / $1,356.89	Professional		$105.76	$264.00	$1,356.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $220.00	Professional		$50.00	$70.00	$220.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $338.80 / $528.00 / $1,540.00	Facility		$338.80	$528.00	$1,540.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $337.46 / $1,048.97 / $1,471.25	Professional		$337.46	$1,048.97	$1,471.25
Quartz Facility/Professional Facility Modifier Low / Median / High Price $880.00 / $2,090.00 / $2,090.00	Facility		$880.00	$2,090.00	$2,090.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $638.00 / $2,200.00 / $2,200.00	Professional		$638.00	$2,200.00	$2,200.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $133.26 / $133.26 / $937.00	Professional		$133.26	$133.26	$937.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $133.26 / $133.26 / $2,402.40	Professional		$133.26	$133.26	$2,402.40
United Facility/Professional Professional Modifier Low / Median / High Price $106.02 / $264.00 / $682.00	Professional		$106.02	$264.00	$682.00