Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $803.17 / $803.17 / $803.17	Facility		$803.17	$803.17	$803.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $697.94 / $803.17 / $1,325.51	Professional		$697.94	$803.17	$1,325.51
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,592.13 / $1,751.34 / $2,897.68	Facility		$1,592.13	$1,751.34	$2,897.68
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,480.68 / $1,480.68 / $1,958.31	Professional		$1,480.68	$1,480.68	$1,958.31
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,145.36 / $3,407.16 / $3,407.16	Facility		$1,145.36	$3,407.16	$3,407.16
Cigna Facility/Professional Facility Modifier Low / Median / High Price $897.58 / $3,291.74 / $6,645.13	Facility		$897.58	$3,291.74	$6,645.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $655.23 / $2,651.64 / $3,013.23	Professional		$655.23	$2,651.64	$3,013.23
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $462.65 / $1,204.76 / $1,830.95	Facility		$462.65	$1,204.76	$1,830.95
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $911.61 / $1,592.13 / $1,915.27	Professional		$911.61	$1,592.13	$1,915.27
Medica Facility/Professional Facility Modifier Low / Median / High Price $800.86 / $1,592.13 / $7,517.91	Facility		$800.86	$1,592.13	$7,517.91
Medica Facility/Professional Professional Modifier Low / Median / High Price $662.59 / $836.07 / $1,791.57	Professional		$662.59	$836.07	$1,791.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $695.94	Professional		$50.00	$70.00	$695.94
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $462.65 / $1,204.76 / $1,830.95	Facility		$462.65	$1,204.76	$1,830.95
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $911.61 / $1,592.13 / $1,915.27	Professional		$911.61	$1,592.13	$1,915.27
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,592.13 / $2,450.23 / $4,299.85	Professional		$1,592.13	$2,450.23	$4,299.85
Quartz Facility/Professional Facility Modifier Low / Median / High Price $897.58 / $3,109.62 / $7,517.91	Facility		$897.58	$3,109.62	$7,517.91
Quartz Facility/Professional Professional Modifier Low / Median / High Price $655.23 / $897.58 / $9,193.29	Professional		$655.23	$897.58	$9,193.29
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,592.13 / $1,592.13 / $1,592.13	Professional		$1,592.13	$1,592.13	$1,592.13
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,592.13 / $1,592.13 / $1,592.13	Professional		$1,592.13	$1,592.13	$1,592.13
United Facility/Professional Facility Modifier Low / Median / High Price $957.27 / $957.27 / $957.27	Facility		$957.27	$957.27	$957.27
United Facility/Professional Professional Modifier Low / Median / High Price $597.19 / $795.60 / $1,541.41	Professional		$597.19	$795.60	$1,541.41