Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $720.00 / $900.00 / $1,338.00	Facility		$720.00	$900.00	$1,338.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $462.00 / $720.00 / $1,338.00	Professional		$462.00	$720.00	$1,338.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,290.00 / $1,560.00 / $1,650.00	Facility		$1,290.00	$1,560.00	$1,650.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $240.00 / $600.00 / $2,569.92	Professional		$240.00	$600.00	$2,569.92
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,524.00 / $1,588.55 / $1,588.55	Facility		$1,524.00	$1,588.55	$1,588.55
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,650.85 / $1,929.15 / $2,959.37	Facility		$1,650.85	$1,929.15	$2,959.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $689.71 / $1,615.68 / $1,836.00	Professional		$689.71	$1,615.68	$1,836.00
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $462.00 / $720.00 / $2,100.00	Facility		$462.00	$720.00	$2,100.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $540.00 / $720.00 / $2,100.00	Facility		$540.00	$720.00	$2,100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $300.00 / $360.00 / $1,850.31	Professional		$300.00	$360.00	$1,850.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,656.00	Professional		$50.00	$70.00	$1,656.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $462.00 / $720.00 / $2,100.00	Facility		$462.00	$720.00	$2,100.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,141.06 / $1,463.22 / $2,006.74	Professional		$1,141.06	$1,463.22	$2,006.74
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,200.00 / $2,850.00 / $2,850.00	Facility		$1,200.00	$2,850.00	$2,850.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $553.73 / $3,000.00 / $3,000.00	Professional		$553.73	$3,000.00	$3,000.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,277.73 / $1,277.73 / $1,277.73	Professional		$1,277.73	$1,277.73	$1,277.73
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,743.73 / $3,276.00 / $3,276.00	Professional		$1,743.73	$3,276.00	$3,276.00
United Facility/Professional Professional Modifier Low / Median / High Price $300.00 / $360.00 / $1,260.00	Professional		$300.00	$360.00	$1,260.00