Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $297.35 / $297.35 / $297.35	Facility		$297.35	$297.35	$297.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $281.89 / $297.35 / $1,170.59	Professional		$281.89	$297.35	$1,170.59
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $405.72 / $405.72 / $669.44	Facility		$405.72	$405.72	$669.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $377.32 / $377.32 / $446.29	Professional		$377.32	$377.32	$446.29
CareSource Facility/Professional Facility Modifier Low / Median / High Price $365.15 / $365.15 / $868.24	Facility		$365.15	$365.15	$868.24
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,090.35 / $1,274.17 / $1,954.60	Facility		$1,090.35	$1,274.17	$1,954.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $170.00 / $587.80 / $767.85	Professional		$170.00	$587.80	$767.85
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $281.89 / $405.72 / $426.01	Facility		$281.89	$405.72	$426.01
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $145.63 / $145.63 / $145.63	Professional		$145.63	$145.63	$145.63
Medica Facility/Professional Facility Modifier Low / Median / High Price $297.35 / $405.72 / $1,898.77	Facility		$297.35	$405.72	$1,898.77
Medica Facility/Professional Professional Modifier Low / Median / High Price $202.41 / $458.80 / $1,232.07	Professional		$202.41	$458.80	$1,232.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $65.00 / $65.00 / $90.00	Professional		$65.00	$65.00	$90.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $281.89 / $405.72 / $426.01	Facility		$281.89	$405.72	$426.01
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $145.63 / $145.63 / $145.63	Professional		$145.63	$145.63	$145.63
Quartz Facility/Professional Professional Modifier Low / Median / High Price $405.72 / $608.58 / $958.32	Professional		$405.72	$608.58	$958.32
Quartz Facility/Professional Facility Modifier Low / Median / High Price $792.42 / $823.61 / $1,898.77	Facility		$792.42	$823.61	$1,898.77
Quartz Facility/Professional Professional Modifier Low / Median / High Price $170.00 / $170.00 / $170.00	Professional		$170.00	$170.00	$170.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $405.72 / $405.72 / $405.72	Professional		$405.72	$405.72	$405.72
Security Health Facility/Professional Facility Modifier Low / Median / High Price $353.94 / $353.94 / $353.94	Facility		$353.94	$353.94	$353.94
Security Health Facility/Professional Professional Modifier Low / Median / High Price $405.72 / $405.72 / $405.72	Professional		$405.72	$405.72	$405.72
United Facility/Professional Professional Modifier Low / Median / High Price $158.47 / $405.72 / $1,232.07	Professional		$158.47	$405.72	$1,232.07