Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $912.00 / $912.00 / $912.00	Facility		$912.00	$912.00	$912.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $585.20 / $714.40 / $912.00	Professional		$585.20	$714.40	$912.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,634.00 / $1,976.00 / $2,090.00	Facility		$1,634.00	$1,976.00	$2,090.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $200.00 / $394.53 / $3,255.24	Professional		$200.00	$394.53	$3,255.24
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,156.66 / $1,857.37 / $1,857.37	Facility		$1,156.66	$1,857.37	$1,857.37
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,091.50 / $2,444.08 / $3,749.29	Facility		$2,091.50	$2,444.08	$3,749.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $816.92 / $2,046.53 / $2,325.60	Professional		$816.92	$2,046.53	$2,325.60
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $585.20 / $912.00 / $2,660.00	Facility		$585.20	$912.00	$2,660.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $684.00 / $912.00 / $2,660.00	Facility		$684.00	$912.00	$2,660.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $380.00 / $456.00 / $2,343.73	Professional		$380.00	$456.00	$2,343.73
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 $585.20 / $912.00 / $2,660.00	Facility		$585.20	$912.00	$2,660.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,269.00 / $1,812.56 / $2,542.23	Professional		$1,269.00	$1,812.56	$2,542.23
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,520.00 / $3,610.00 / $3,610.00	Facility		$1,520.00	$3,610.00	$3,610.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,040.00 / $3,800.00 / $3,800.00	Professional		$3,040.00	$3,800.00	$3,800.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,618.45 / $1,618.45 / $1,618.45	Professional		$1,618.45	$1,618.45	$1,618.45
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,208.71 / $4,149.60 / $4,149.60	Professional		$2,208.71	$4,149.60	$4,149.60
United Facility/Professional Facility Modifier Low / Median / High Price $760.00 / $760.00 / $760.00	Facility		$760.00	$760.00	$760.00
United Facility/Professional Professional Modifier Low / Median / High Price $319.20 / $456.00 / $1,596.00	Professional		$319.20	$456.00	$1,596.00