Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $704.36 / $704.36 / $704.36	Facility		$704.36	$704.36	$704.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $482.01 / $704.36 / $1,169.51	Professional		$482.01	$704.36	$1,169.51
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,396.26 / $1,535.89 / $2,541.19	Facility		$1,396.26	$1,535.89	$2,541.19
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,256.63 / $1,298.52 / $1,717.39	Professional		$1,256.63	$1,298.52	$1,717.39
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,004.47 / $2,988.00 / $2,988.00	Facility		$1,004.47	$2,988.00	$2,988.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $930.44 / $2,886.47 / $5,827.78	Facility		$930.44	$2,886.47	$5,827.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $679.22 / $2,023.59 / $2,642.54	Professional		$679.22	$2,023.59	$2,642.54
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $372.67 / $1,056.54 / $1,605.70	Facility		$372.67	$1,056.54	$1,605.70
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $799.46 / $1,157.08 / $1,675.51	Professional		$799.46	$1,157.08	$1,675.51
Medica Facility/Professional Facility Modifier Low / Median / High Price $645.10 / $1,396.26 / $6,077.59	Facility		$645.10	$1,396.26	$6,077.59
Medica Facility/Professional Professional Modifier Low / Median / High Price $628.95 / $869.56 / $1,520.36	Professional		$628.95	$869.56	$1,520.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $942.27	Professional		$50.00	$70.00	$942.27
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $372.67 / $1,056.54 / $1,605.70	Facility		$372.67	$1,056.54	$1,605.70
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $799.46 / $1,157.08 / $1,675.51	Professional		$799.46	$1,157.08	$1,675.51
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,396.26 / $2,148.80 / $3,463.77	Professional		$1,396.26	$2,148.80	$3,463.77
Quartz Facility/Professional Facility Modifier Low / Median / High Price $930.44 / $2,727.08 / $6,077.59	Facility		$930.44	$2,727.08	$6,077.59
Quartz Facility/Professional Professional Modifier Low / Median / High Price $679.22 / $930.44 / $7,636.71	Professional		$679.22	$930.44	$7,636.71
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,396.26 / $1,396.26 / $1,396.26	Professional		$1,396.26	$1,396.26	$1,396.26
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,396.26 / $1,396.26 / $1,396.26	Professional		$1,396.26	$1,396.26	$1,396.26
United Facility/Professional Professional Modifier Low / Median / High Price $521.74 / $769.67 / $1,396.26	Professional		$521.74	$769.67	$1,396.26