Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $757.93 / $757.93 / $757.93	Facility		$757.93	$757.93	$757.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $597.29 / $757.93 / $1,134.36	Professional		$597.29	$757.93	$1,134.36
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,502.44 / $1,652.68 / $2,734.44	Facility		$1,502.44	$1,652.68	$2,734.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,397.27 / $1,397.27 / $1,848.00	Professional		$1,397.27	$1,397.27	$1,848.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,080.84 / $3,215.22 / $3,215.22	Facility		$1,080.84	$3,215.22	$3,215.22
Cigna Facility/Professional Facility Modifier Low / Median / High Price $755.39 / $3,106.00 / $6,271.45	Facility		$755.39	$3,106.00	$6,271.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $551.42 / $2,177.34 / $2,843.49	Professional		$551.42	$2,177.34	$2,843.49
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $389.35 / $1,136.90 / $1,727.81	Facility		$389.35	$1,136.90	$1,727.81
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $860.26 / $1,502.44 / $1,802.93	Professional		$860.26	$1,502.44	$1,802.93
Medica Facility/Professional Facility Modifier Low / Median / High Price $673.98 / $1,502.44 / $6,411.18	Facility		$673.98	$1,502.44	$6,411.18
Medica Facility/Professional Professional Modifier Low / Median / High Price $598.54 / $749.55 / $1,635.98	Professional		$598.54	$749.55	$1,635.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $705.43	Professional		$50.00	$70.00	$705.43
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $389.35 / $1,136.90 / $1,727.81	Facility		$389.35	$1,136.90	$1,727.81
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $860.26 / $1,502.44 / $1,802.93	Professional		$860.26	$1,502.44	$1,802.93
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,502.44 / $2,307.40 / $3,618.34	Professional		$1,502.44	$2,307.40	$3,618.34
Quartz Facility/Professional Facility Modifier Low / Median / High Price $755.39 / $2,934.46 / $6,411.18	Facility		$755.39	$2,934.46	$6,411.18
Quartz Facility/Professional Professional Modifier Low / Median / High Price $551.42 / $755.39 / $8,001.72	Professional		$551.42	$755.39	$8,001.72
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,502.44 / $1,502.44 / $1,502.44	Professional		$1,502.44	$1,502.44	$1,502.44
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,199.66 / $1,502.44 / $1,502.44	Professional		$1,199.66	$1,502.44	$1,502.44
United Facility/Professional Professional Modifier Low / Median / High Price $502.59 / $749.55 / $1,332.09	Professional		$502.59	$749.55	$1,332.09