Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $542.36 / $542.36 / $542.36	Facility		$542.36	$542.36	$542.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $374.27 / $542.36 / $900.52	Professional		$374.27	$542.36	$900.52
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,075.13 / $1,182.64 / $1,956.74	Facility		$1,075.13	$1,182.64	$1,956.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $929.87 / $999.87 / $1,322.40	Professional		$929.87	$999.87	$1,322.40
CareSource Facility/Professional Facility Modifier Low / Median / High Price $773.45 / $2,300.78 / $2,300.78	Facility		$773.45	$2,300.78	$2,300.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $695.50 / $2,222.32 / $4,487.00	Facility		$695.50	$2,222.32	$4,487.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $507.72 / $1,558.13 / $2,034.76	Professional		$507.72	$1,558.13	$2,034.76
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $265.81 / $813.54 / $1,236.40	Facility		$265.81	$813.54	$1,236.40
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $615.61 / $1,002.06 / $1,290.16	Professional		$615.61	$1,002.06	$1,290.16
Medica Facility/Professional Facility Modifier Low / Median / High Price $460.13 / $1,075.13 / $4,434.30	Facility		$460.13	$1,075.13	$4,434.30
Medica Facility/Professional Professional Modifier Low / Median / High Price $436.56 / $620.36 / $1,170.68	Professional		$436.56	$620.36	$1,170.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $604.13	Professional		$50.00	$70.00	$604.13
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $265.81 / $813.54 / $1,236.40	Facility		$265.81	$813.54	$1,236.40
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $615.61 / $1,002.06 / $1,290.16	Professional		$615.61	$1,002.06	$1,290.16
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,075.13 / $1,612.70 / $2,470.11	Professional		$1,075.13	$1,612.70	$2,470.11
Quartz Facility/Professional Facility Modifier Low / Median / High Price $695.50 / $2,099.86 / $4,434.30	Facility		$695.50	$2,099.86	$4,434.30
Quartz Facility/Professional Professional Modifier Low / Median / High Price $507.72 / $695.50 / $5,447.03	Professional		$507.72	$695.50	$5,447.03
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,075.13 / $1,075.13 / $1,075.13	Professional		$1,075.13	$1,075.13	$1,075.13
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,075.13 / $1,075.13 / $1,075.13	Professional		$1,075.13	$1,075.13	$1,075.13
United Facility/Professional Professional Modifier Low / Median / High Price $357.58 / $536.37 / $922.09	Professional		$357.58	$536.37	$922.09