Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $624.00 / $780.00 / $1,159.59	Facility		$624.00	$780.00	$1,159.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $400.40 / $494.00 / $790.40	Professional		$400.40	$494.00	$790.40
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,118.00 / $1,352.00 / $1,430.00	Facility		$1,118.00	$1,352.00	$1,430.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $208.00 / $520.00 / $2,227.27	Professional		$208.00	$520.00	$2,227.27
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,270.83 / $1,270.83 / $1,320.80	Facility		$1,270.83	$1,270.83	$1,320.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,430.98 / $1,672.21 / $2,565.21	Facility		$1,430.98	$1,672.21	$2,565.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $597.61 / $1,400.26 / $1,591.20	Professional		$597.61	$1,400.26	$1,591.20
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $400.40 / $624.00 / $1,820.00	Facility		$400.40	$624.00	$1,820.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $468.00 / $624.00 / $1,820.00	Facility		$468.00	$624.00	$1,820.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $260.00 / $312.00 / $1,603.60	Professional		$260.00	$312.00	$1,603.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $260.00	Professional		$50.00	$70.00	$260.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $400.40 / $624.00 / $1,820.00	Facility		$400.40	$624.00	$1,820.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $988.42 / $1,268.39 / $1,739.53	Professional		$988.42	$1,268.39	$1,739.53
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,040.00 / $2,470.00 / $2,470.00	Facility		$1,040.00	$2,470.00	$2,470.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $754.00 / $2,600.00 / $2,600.00	Professional		$754.00	$2,600.00	$2,600.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,107.35 / $1,107.35 / $1,107.35	Professional		$1,107.35	$1,107.35	$1,107.35
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,511.23 / $2,839.20 / $2,839.20	Professional		$1,511.23	$2,839.20	$2,839.20
United Facility/Professional Professional Modifier Low / Median / High Price $226.04 / $312.00 / $1,092.00	Professional		$226.04	$312.00	$1,092.00