Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $314.58 / $314.58 / $314.58	Facility		$314.58	$314.58	$314.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $314.58 / $321.77 / $649.32	Professional		$314.58	$321.77	$649.32
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $623.59 / $685.95 / $1,134.93	Facility		$623.59	$685.95	$1,134.93
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $561.23 / $579.94 / $767.01	Professional		$561.23	$579.94	$767.01
CareSource Facility/Professional Facility Modifier Low / Median / High Price $448.61 / $1,334.48 / $1,334.48	Facility		$448.61	$1,334.48	$1,334.48
Cigna Facility/Professional Facility Modifier Low / Median / High Price $389.66 / $1,288.91 / $2,603.19	Facility		$389.66	$1,288.91	$2,603.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $284.45 / $903.75 / $1,180.20	Professional		$284.45	$903.75	$1,180.20
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $200.84 / $471.87 / $717.13	Facility		$200.84	$471.87	$717.13
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $357.05 / $623.59 / $748.31	Professional		$357.05	$623.59	$748.31
Medica Facility/Professional Facility Modifier Low / Median / High Price $314.58 / $623.59 / $3,225.13	Facility		$314.58	$623.59	$3,225.13
Medica Facility/Professional Professional Modifier Low / Median / High Price $289.94 / $416.66 / $685.96	Professional		$289.94	$416.66	$685.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $420.83	Professional		$50.00	$70.00	$420.83
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $200.84 / $481.31 / $717.13	Facility		$200.84	$481.31	$717.13
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $357.05 / $623.59 / $748.31	Professional		$357.05	$623.59	$748.31
Quartz Facility/Professional Professional Modifier Low / Median / High Price $623.59 / $959.67 / $1,866.88	Professional		$623.59	$959.67	$1,866.88
Quartz Facility/Professional Facility Modifier Low / Median / High Price $389.66 / $1,217.96 / $3,225.13	Facility		$389.66	$1,217.96	$3,225.13
Quartz Facility/Professional Professional Modifier Low / Median / High Price $284.45 / $389.66 / $3,687.45	Professional		$284.45	$389.66	$3,687.45
Security Health Facility/Professional Professional Modifier Low / Median / High Price $623.59 / $623.59 / $623.59	Professional		$623.59	$623.59	$623.59
Security Health Facility/Professional Professional Modifier Low / Median / High Price $497.92 / $623.59 / $623.59	Professional		$497.92	$623.59	$623.59
United Facility/Professional Professional Modifier Low / Median / High Price $243.59 / $374.15 / $534.82	Professional		$243.59	$374.15	$534.82