Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $711.15 / $711.15 / $711.15	Facility		$711.15	$711.15	$711.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $683.69 / $755.88 / $1,298.45	Professional		$683.69	$755.88	$1,298.45
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,409.73 / $1,550.70 / $2,565.71	Facility		$1,409.73	$1,550.70	$2,565.71
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,268.75 / $1,311.05 / $1,733.96	Professional		$1,268.75	$1,311.05	$1,733.96
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,014.16 / $3,016.82 / $3,016.82	Facility		$1,014.16	$3,016.82	$3,016.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $840.60 / $2,914.63 / $5,883.77	Facility		$840.60	$2,914.63	$5,883.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $613.64 / $2,042.81 / $2,668.03	Professional		$613.64	$2,042.81	$2,668.03
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $405.35 / $1,066.73 / $1,621.19	Facility		$405.35	$1,066.73	$1,621.19
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $807.18 / $1,409.73 / $1,691.68	Professional		$807.18	$1,409.73	$1,691.68
Medica Facility/Professional Facility Modifier Low / Median / High Price $666.85 / $1,409.73 / $6,648.31	Facility		$666.85	$1,409.73	$6,648.31
Medica Facility/Professional Professional Modifier Low / Median / High Price $580.52 / $746.85 / $1,535.02	Professional		$580.52	$746.85	$1,535.02
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $874.43	Professional		$50.00	$70.00	$874.43
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $405.35 / $1,066.73 / $1,621.19	Facility		$405.35	$1,066.73	$1,621.19
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $807.18 / $1,409.73 / $1,691.68	Professional		$807.18	$1,409.73	$1,691.68
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,409.73 / $2,169.52 / $3,766.89	Professional		$1,409.73	$2,169.52	$3,766.89
Quartz Facility/Professional Facility Modifier Low / Median / High Price $840.60 / $2,753.38 / $6,648.31	Facility		$840.60	$2,753.38	$6,648.31
Quartz Facility/Professional Professional Modifier Low / Median / High Price $613.64 / $840.60 / $8,054.69	Professional		$613.64	$840.60	$8,054.69
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,409.73 / $1,409.73 / $1,409.73	Professional		$1,409.73	$1,409.73	$1,409.73
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,125.64 / $1,409.73 / $1,409.73	Professional		$1,125.64	$1,409.73	$1,409.73
United Facility/Professional Professional Modifier Low / Median / High Price $523.23 / $703.30 / $1,348.00	Professional		$523.23	$703.30	$1,348.00