Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $879.27 / $879.27 / $879.27	Facility		$879.27	$879.27	$879.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $492.35 / $795.00 / $1,004.88	Professional		$492.35	$795.00	$1,004.88
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $967.00 / $967.00 / $1,759.94	Facility		$967.00	$967.00	$1,759.94
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $786.31 / $899.31 / $1,189.41	Professional		$786.31	$899.31	$1,189.41
CareSource Facility/Professional Facility Modifier Low / Median / High Price $106.37 / $668.12 / $1,086.03	Facility		$106.37	$668.12	$1,086.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $106.37 / $732.94 / $1,091.96	Professional		$106.37	$732.94	$1,091.96
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,604.23 / $3,043.26 / $4,668.43	Facility		$2,604.23	$3,043.26	$4,668.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $750.60 / $4,077.00 / $5,096.25	Professional		$750.60	$4,077.00	$5,096.25
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $93.86 / $775.08 / $1,318.91	Facility		$93.86	$775.08	$1,318.91
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $116.04 / $159.41 / $159.41	Professional		$116.04	$159.41	$159.41
Medica Facility/Professional Facility Modifier Low / Median / High Price $96.70 / $984.74 / $4,832.10	Facility		$96.70	$984.74	$4,832.10
Medica Facility/Professional Professional Modifier Low / Median / High Price $60.85 / $106.42 / $2,573.64	Professional		$60.85	$106.42	$2,573.64
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $65.00 / $82.00	Professional		$50.00	$65.00	$82.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $89.68 / $825.68 / $1,318.91	Facility		$89.68	$825.68	$1,318.91
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $116.04 / $159.41 / $159.41	Professional		$116.04	$159.41	$159.41
Quartz Facility/Professional Professional Modifier Low / Median / High Price $107.97 / $215.34 / $295.33	Professional		$107.97	$215.34	$295.33
Quartz Facility/Professional Facility Modifier Low / Median / High Price $65.00 / $4,782.72 / $4,832.10	Facility		$65.00	$4,782.72	$4,832.10
Quartz Facility/Professional Professional Modifier Low / Median / High Price $750.60 / $3,913.52 / $4,687.97	Professional		$750.60	$3,913.52	$4,687.97
United Facility/Professional Professional Modifier Low / Median / High Price $50.71 / $103.90 / $779.26	Professional		$50.71	$103.90	$779.26