Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $404.41 / $777.66 / $893.09	Facility		$404.41	$777.66	$893.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $392.63 / $396.56 / $471.15	Professional		$392.63	$396.56	$471.15
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $490.79 / $726.37 / $875.56	Facility		$490.79	$726.37	$875.56
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $392.63 / $392.63 / $530.04	Professional		$392.63	$392.63	$530.04
CareSource Facility/Professional Facility Modifier Low / Median / High Price $628.21 / $706.73 / $719.65	Facility		$628.21	$706.73	$719.65
Cigna Facility/Professional Facility Modifier Low / Median / High Price $392.63 / $568.42 / $1,039.86	Facility		$392.63	$568.42	$1,039.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $392.24 / $476.02 / $567.73	Professional		$392.24	$476.02	$567.73
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $291.26 / $392.63 / $648.33	Facility		$291.26	$392.63	$648.33
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $583.25 / $785.26 / $785.26	Professional		$583.25	$785.26	$785.26
Medica Facility/Professional Facility Modifier Low / Median / High Price $326.20 / $388.83 / $544.36	Facility		$326.20	$388.83	$544.36
Medica Facility/Professional Professional Modifier Low / Median / High Price $388.83 / $432.85 / $6,283.71	Professional		$388.83	$432.85	$6,283.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $85.00	Professional		$50.00	$70.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $291.26 / $392.63 / $648.33	Facility		$291.26	$392.63	$648.33
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $583.25 / $785.26 / $785.26	Professional		$583.25	$785.26	$785.26
Quartz Facility/Professional Professional Modifier Low / Median / High Price $392.62 / $506.55 / $1,156.00	Professional		$392.62	$506.55	$1,156.00
Quartz Facility/Professional Facility Modifier Low / Median / High Price $374.16 / $392.63 / $1,868.85	Facility		$374.16	$392.63	$1,868.85
Quartz Facility/Professional Professional Modifier Low / Median / High Price $392.63 / $687.59 / $6,283.71	Professional		$392.63	$687.59	$6,283.71
Security Health Facility/Professional Professional Modifier Low / Median / High Price $345.29 / $551.25 / $551.25	Professional		$345.29	$551.25	$551.25
United Facility/Professional Facility Modifier Low / Median / High Price $392.63 / $392.63 / $392.63	Facility		$392.63	$392.63	$392.63
United Facility/Professional Professional Modifier Low / Median / High Price $392.63 / $392.63 / $467.23	Professional		$392.63	$392.63	$467.23