Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $694.57 / $694.57 / $694.57	Facility		$694.57	$694.57	$694.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $571.08 / $694.57 / $1,153.24	Professional		$571.08	$694.57	$1,153.24
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,376.84 / $1,514.52 / $2,505.85	Facility		$1,376.84	$1,514.52	$2,505.85
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,190.82 / $1,280.46 / $1,693.51	Professional		$1,190.82	$1,280.46	$1,693.51
CareSource Facility/Professional Facility Modifier Low / Median / High Price $990.50 / $2,946.44 / $2,946.44	Facility		$990.50	$2,946.44	$2,946.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $809.08 / $3,039.56 / $5,746.61	Facility		$809.08	$3,039.56	$5,746.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $687.72 / $2,026.92 / $2,605.78	Professional		$687.72	$2,026.92	$2,605.78
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $417.02 / $1,041.85 / $1,583.37	Facility		$417.02	$1,041.85	$1,583.37
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $788.34 / $1,294.82 / $1,652.21	Professional		$788.34	$1,294.82	$1,652.21
Medica Facility/Professional Facility Modifier Low / Median / High Price $694.57 / $1,376.84 / $5,928.30	Facility		$694.57	$1,376.84	$5,928.30
Medica Facility/Professional Professional Modifier Low / Median / High Price $640.16 / $919.96 / $1,499.21	Professional		$640.16	$919.96	$1,499.21
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $65.00 / $85.00	Professional		$50.00	$65.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $417.02 / $1,041.85 / $1,583.37	Facility		$417.02	$1,041.85	$1,583.37
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $788.34 / $1,294.82 / $1,652.21	Professional		$788.34	$1,294.82	$1,652.21
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,376.84 / $2,118.92 / $3,876.29	Professional		$1,376.84	$2,118.92	$3,876.29
Quartz Facility/Professional Facility Modifier Low / Median / High Price $809.08 / $2,689.14 / $5,928.30	Facility		$809.08	$2,689.14	$5,928.30
Quartz Facility/Professional Professional Modifier Low / Median / High Price $687.72 / $809.08 / $8,286.86	Professional		$687.72	$809.08	$8,286.86
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,376.84 / $1,376.84 / $1,376.84	Professional		$1,376.84	$1,376.84	$1,376.84
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,376.84 / $1,376.84 / $1,376.84	Professional		$1,376.84	$1,376.84	$1,376.84
United Facility/Professional Professional Modifier Low / Median / High Price $548.52 / $861.30 / $1,220.73	Professional		$548.52	$861.30	$1,220.73