Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $956.63 / $956.63 / $956.63	Facility		$956.63	$956.63	$956.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.34 / $956.63 / $1,203.97	Professional		$128.34	$956.63	$1,203.97
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,647.63 / $1,812.39 / $2,998.69	Facility		$1,647.63	$1,812.39	$2,998.69
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,532.30 / $1,532.30 / $2,026.58	Professional		$1,532.30	$1,532.30	$2,026.58
CareSource Facility/Professional Facility Modifier Low / Median / High Price $111.51 / $3,525.93 / $3,525.93	Facility		$111.51	$3,525.93	$3,525.93
Cigna Facility/Professional Facility Modifier Low / Median / High Price $120.00 / $4,914.00 / $6,877.46	Facility		$120.00	$4,914.00	$6,877.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.00 / $2,387.81 / $3,118.26	Professional		$102.00	$2,387.81	$3,118.26
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $956.63 / $1,425.38 / $1,894.77	Facility		$956.63	$1,425.38	$1,894.77
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,608.14 / $1,647.63 / $1,977.16	Professional		$1,608.14	$1,647.63	$1,977.16
Medica Facility/Professional Facility Modifier Low / Median / High Price $956.63 / $1,721.93 / $7,674.31	Facility		$956.63	$1,721.93	$7,674.31
Medica Facility/Professional Professional Modifier Low / Median / High Price $69.12 / $85.63 / $1,608.14	Professional		$69.12	$85.63	$1,608.14
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $58.40 / $70.00	Professional		$50.00	$58.40	$70.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $956.63 / $1,434.95 / $1,894.77	Facility		$956.63	$1,434.95	$1,894.77
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,608.14 / $1,647.63 / $1,977.16	Professional		$1,608.14	$1,647.63	$1,977.16
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,647.63 / $2,471.44 / $4,407.25	Professional		$1,647.63	$2,471.44	$4,407.25
Quartz Facility/Professional Facility Modifier Low / Median / High Price $120.00 / $3,218.02 / $7,674.31	Facility		$120.00	$3,218.02	$7,674.31
Quartz Facility/Professional Professional Modifier Low / Median / High Price $102.00 / $120.00 / $8,311.57	Professional		$102.00	$120.00	$8,311.57
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,647.63 / $1,647.63 / $1,647.63	Professional		$1,647.63	$1,647.63	$1,647.63
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,647.63 / $1,647.63 / $1,647.63	Professional		$1,647.63	$1,647.63	$1,647.63
United Facility/Professional Professional Modifier Low / Median / High Price $68.50 / $85.63 / $575.10	Professional		$68.50	$85.63	$575.10