Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $639.94 / $639.94 / $639.94	Facility		$639.94	$639.94	$639.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $402.13 / $575.95 / $754.83	Professional		$402.13	$575.95	$754.83
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $962.60 / $1,751.93 / $1,751.93	Facility		$962.60	$1,751.93	$1,751.93
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $723.07 / $895.22 / $1,203.25	Professional		$723.07	$895.22	$1,203.25
CareSource Facility/Professional Facility Modifier Low / Median / High Price $67.86 / $109.02 / $324.27	Facility		$67.86	$109.02	$324.27
Cigna Facility/Professional Facility Modifier Low / Median / High Price $458.33 / $458.33 / $2,568.19	Facility		$458.33	$458.33	$2,568.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $389.58 / $532.95 / $1,396.88	Professional		$389.58	$532.95	$1,396.88
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $268.89 / $855.68 / $1,151.89	Facility		$268.89	$855.68	$1,151.89
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,006.68 / $1,006.68 / $1,155.11	Professional		$1,006.68	$1,006.68	$1,155.11
Medica Facility/Professional Facility Modifier Low / Median / High Price $268.89 / $1,106.99 / $4,986.09	Facility		$268.89	$1,106.99	$4,986.09
Medica Facility/Professional Professional Modifier Low / Median / High Price $475.44 / $704.57 / $1,258.34	Professional		$475.44	$704.57	$1,258.34
Molina Facility/Professional Professional Modifier Low / Median / High Price $2.95 / $58.40 / $1,109.84	Professional		$2.95	$58.40	$1,109.84
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $268.89 / $959.91 / $1,151.89	Facility		$268.89	$959.91	$1,151.89
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,006.68 / $1,006.68 / $1,155.11	Professional		$1,006.68	$1,006.68	$1,155.11
Quartz Facility/Professional Professional Modifier Low / Median / High Price $107.48 / $222.44 / $288.82	Professional		$107.48	$222.44	$288.82
Quartz Facility/Professional Facility Modifier Low / Median / High Price $458.33 / $1,794.78 / $4,986.09	Facility		$458.33	$1,794.78	$4,986.09
Quartz Facility/Professional Professional Modifier Low / Median / High Price $389.58 / $458.33 / $458.33	Professional		$389.58	$458.33	$458.33
United Facility/Professional Professional Modifier Low / Median / High Price $435.16 / $682.60 / $1,258.34	Professional		$435.16	$682.60	$1,258.34