Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $682.67 / $682.67 / $682.67	Facility		$682.67	$682.67	$682.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $468.25 / $682.67 / $1,133.49	Professional		$468.25	$682.67	$1,133.49
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,353.27 / $1,488.60 / $2,462.94	Facility		$1,353.27	$1,488.60	$2,462.94
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,258.54 / $1,258.54 / $1,664.52	Professional		$1,258.54	$1,258.54	$1,664.52
CareSource Facility/Professional Facility Modifier Low / Median / High Price $973.54 / $2,896.00 / $2,896.00	Facility		$973.54	$2,896.00	$2,896.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $702.38 / $2,797.37 / $5,648.64	Facility		$702.38	$2,797.37	$5,648.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $512.74 / $1,961.25 / $2,561.16	Professional		$512.74	$1,961.25	$2,561.16
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $362.03 / $1,024.01 / $1,556.26	Facility		$362.03	$1,024.01	$1,556.26
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $774.85 / $1,353.27 / $1,623.92	Professional		$774.85	$1,353.27	$1,623.92
Medica Facility/Professional Facility Modifier Low / Median / High Price $626.69 / $1,353.27 / $5,917.02	Facility		$626.69	$1,353.27	$5,917.02
Medica Facility/Professional Professional Modifier Low / Median / High Price $609.58 / $844.74 / $1,473.54	Professional		$609.58	$844.74	$1,473.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $789.47	Professional		$50.00	$70.00	$789.47
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $362.03 / $1,024.01 / $1,556.26	Facility		$362.03	$1,024.01	$1,556.26
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $774.85 / $1,353.27 / $1,623.92	Professional		$774.85	$1,353.27	$1,623.92
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,353.27 / $2,082.65 / $3,364.40	Professional		$1,353.27	$2,082.65	$3,364.40
Quartz Facility/Professional Facility Modifier Low / Median / High Price $702.38 / $2,643.10 / $5,917.02	Facility		$702.38	$2,643.10	$5,917.02
Quartz Facility/Professional Professional Modifier Low / Median / High Price $512.74 / $702.38 / $6,703.04	Professional		$512.74	$702.38	$6,703.04
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,353.27 / $1,353.27 / $1,353.27	Professional		$1,353.27	$1,353.27	$1,353.27
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,080.55 / $1,353.27 / $1,353.27	Professional		$1,080.55	$1,353.27	$1,353.27
United Facility/Professional Professional Modifier Low / Median / High Price $450.09 / $747.70 / $1,160.64	Professional		$450.09	$747.70	$1,160.64