Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $698.29 / $698.29 / $698.29	Facility		$698.29	$698.29	$698.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $478.88 / $698.29 / $1,159.42	Professional		$478.88	$698.29	$1,159.42
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,384.22 / $1,522.64 / $2,519.28	Facility		$1,384.22	$1,522.64	$2,519.28
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,245.79 / $1,287.32 / $1,702.59	Professional		$1,245.79	$1,287.32	$1,702.59
CareSource Facility/Professional Facility Modifier Low / Median / High Price $995.80 / $2,962.23 / $2,962.23	Facility		$995.80	$2,962.23	$2,962.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $895.43 / $2,862.08 / $5,777.40	Facility		$895.43	$2,862.08	$5,777.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $653.66 / $2,005.78 / $2,619.75	Professional		$653.66	$2,005.78	$2,619.75
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $359.09 / $1,047.44 / $1,591.85	Facility		$359.09	$1,047.44	$1,591.85
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $792.56 / $1,201.58 / $1,661.06	Professional		$792.56	$1,201.58	$1,661.06
Medica Facility/Professional Facility Modifier Low / Median / High Price $621.60 / $1,384.22 / $5,814.95	Facility		$621.60	$1,384.22	$5,814.95
Medica Facility/Professional Professional Modifier Low / Median / High Price $611.16 / $837.88 / $1,507.24	Professional		$611.16	$837.88	$1,507.24
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $807.50	Professional		$50.00	$70.00	$807.50
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $359.09 / $1,047.44 / $1,591.85	Facility		$359.09	$1,047.44	$1,591.85
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $792.56 / $1,201.58 / $1,661.06	Professional		$792.56	$1,201.58	$1,661.06
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,384.22 / $2,127.88 / $3,337.30	Professional		$1,384.22	$2,127.88	$3,337.30
Quartz Facility/Professional Facility Modifier Low / Median / High Price $895.43 / $2,703.56 / $5,814.95	Facility		$895.43	$2,703.56	$5,814.95
Quartz Facility/Professional Professional Modifier Low / Median / High Price $653.66 / $895.43 / $6,083.01	Professional		$653.66	$895.43	$6,083.01
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,384.22 / $1,384.22 / $1,384.22	Professional		$1,384.22	$1,384.22	$1,384.22
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,105.26 / $1,384.22 / $1,384.22	Professional		$1,105.26	$1,384.22	$1,384.22
United Facility/Professional Professional Modifier Low / Median / High Price $502.73 / $830.53 / $1,384.22	Professional		$502.73	$830.53	$1,384.22