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 $623.20 / $714.40 / $912.00	Professional		$623.20	$714.40	$912.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $304.00 / $304.00 / $2,675.20	Professional		$304.00	$304.00	$2,675.20
CareSource Facility/Professional Facility Modifier Low / Median / High Price $522.88 / $760.00 / $1,156.66	Facility		$522.88	$760.00	$1,156.66
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 $873.50 / $2,046.53 / $2,325.60	Professional		$873.50	$2,046.53	$2,325.60
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $380.00 / $684.00 / $972.80	Facility		$380.00	$684.00	$972.80
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $760.00 / $760.00 / $760.00	Professional		$760.00	$760.00	$760.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $380.00 / $760.00 / $3,610.00	Facility		$380.00	$760.00	$3,610.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $440.80 / $760.00 / $1,596.00	Professional		$440.80	$760.00	$1,596.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $55.00 / $65.00 / $380.00	Professional		$55.00	$65.00	$380.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $380.00 / $684.00 / $972.80	Facility		$380.00	$684.00	$972.80
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $760.00 / $760.00 / $760.00	Professional		$760.00	$760.00	$760.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $893.00 / $1,812.56 / $2,585.00	Professional		$893.00	$1,812.56	$2,585.00
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,520.00 / $1,520.00 / $3,610.00	Facility		$1,520.00	$1,520.00	$3,610.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $402.80 / $402.80 / $402.80	Professional		$402.80	$402.80	$402.80
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 $3,990.00 / $4,149.60 / $4,149.60	Professional		$3,990.00	$4,149.60	$4,149.60
United Facility/Professional Facility Modifier Low / Median / High Price $912.00 / $912.00 / $912.00	Facility		$912.00	$912.00	$912.00
United Facility/Professional Professional Modifier Low / Median / High Price $380.00 / $456.00 / $1,414.66	Professional		$380.00	$456.00	$1,414.66