Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $698.76 / $698.76 / $698.76	Facility		$698.76	$698.76	$698.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $571.63 / $698.76 / $1,085.63	Professional		$571.63	$698.76	$1,085.63
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,385.15 / $1,523.67 / $2,520.96	Facility		$1,385.15	$1,523.67	$2,520.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,288.19 / $1,288.19 / $1,703.73	Professional		$1,288.19	$1,288.19	$1,703.73
CareSource Facility/Professional Facility Modifier Low / Median / High Price $996.47 / $2,964.22 / $2,964.22	Facility		$996.47	$2,964.22	$2,964.22
Cigna Facility/Professional Facility Modifier Low / Median / High Price $752.15 / $2,863.97 / $5,781.60	Facility		$752.15	$2,863.97	$5,781.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $549.07 / $2,306.92 / $2,621.51	Professional		$549.07	$2,306.92	$2,621.51
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $387.68 / $1,048.14 / $1,592.92	Facility		$387.68	$1,048.14	$1,592.92
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $793.11 / $1,385.15 / $1,662.18	Professional		$793.11	$1,385.15	$1,662.18
Medica Facility/Professional Facility Modifier Low / Median / High Price $671.10 / $1,385.15 / $6,344.91	Facility		$671.10	$1,385.15	$6,344.91
Medica Facility/Professional Professional Modifier Low / Median / High Price $555.23 / $714.32 / $1,508.26	Professional		$555.23	$714.32	$1,508.26
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $806.85	Professional		$50.00	$70.00	$806.85
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $387.68 / $1,048.14 / $1,592.92	Facility		$387.68	$1,048.14	$1,592.92
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $793.11 / $1,385.15 / $1,662.18	Professional		$793.11	$1,385.15	$1,662.18
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,385.15 / $2,131.71 / $3,603.28	Professional		$1,385.15	$2,131.71	$3,603.28
Quartz Facility/Professional Facility Modifier Low / Median / High Price $752.15 / $2,705.38 / $6,344.91	Facility		$752.15	$2,705.38	$6,344.91
Quartz Facility/Professional Professional Modifier Low / Median / High Price $549.07 / $752.15 / $7,124.59	Professional		$549.07	$752.15	$7,124.59
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,385.15 / $1,385.15 / $1,385.15	Professional		$1,385.15	$1,385.15	$1,385.15
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,385.15 / $1,385.15 / $1,385.15	Professional		$1,385.15	$1,385.15	$1,385.15
United Facility/Professional Professional Modifier Low / Median / High Price $500.43 / $691.04 / $1,228.09	Professional		$500.43	$691.04	$1,228.09