Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $758.90 / $758.90 / $758.90	Facility		$758.90	$758.90	$758.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $718.30 / $758.90 / $1,364.17	Professional		$718.30	$758.90	$1,364.17
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,504.38 / $1,654.82 / $2,737.97	Facility		$1,504.38	$1,654.82	$2,737.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,399.07 / $1,399.07 / $1,850.38	Professional		$1,399.07	$1,399.07	$1,850.38
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,082.25 / $3,219.37 / $3,219.37	Facility		$1,082.25	$3,219.37	$3,219.37
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,038.85 / $3,321.08 / $6,279.84	Facility		$1,038.85	$3,321.08	$6,279.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $758.37 / $2,180.16 / $2,847.15	Professional		$758.37	$2,180.16	$2,847.15
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $432.84 / $1,138.34 / $1,730.04	Facility		$432.84	$1,138.34	$1,730.04
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $861.37 / $1,468.32 / $1,805.26	Professional		$861.37	$1,468.32	$1,805.26
Medica Facility/Professional Facility Modifier Low / Median / High Price $749.26 / $1,504.38 / $7,005.45	Facility		$749.26	$1,504.38	$7,005.45
Medica Facility/Professional Professional Modifier Low / Median / High Price $656.92 / $788.05 / $1,638.08	Professional		$656.92	$788.05	$1,638.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $596.41	Professional		$50.00	$70.00	$596.41
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $432.84 / $1,138.34 / $1,730.04	Facility		$432.84	$1,138.34	$1,730.04
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $861.37 / $1,468.32 / $1,805.26	Professional		$861.37	$1,468.32	$1,805.26
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,504.38 / $2,315.19 / $4,022.83	Professional		$1,504.38	$2,315.19	$4,022.83
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,038.85 / $2,938.24 / $7,005.45	Facility		$1,038.85	$2,938.24	$7,005.45
Quartz Facility/Professional Professional Modifier Low / Median / High Price $758.37 / $1,038.85 / $7,574.03	Professional		$758.37	$1,038.85	$7,574.03
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,504.38 / $1,504.38 / $1,504.38	Professional		$1,504.38	$1,504.38	$1,504.38
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,504.38 / $1,504.38 / $1,504.38	Professional		$1,504.38	$1,504.38	$1,504.38
United Facility/Professional Professional Modifier Low / Median / High Price $558.72 / $750.52 / $1,438.50	Professional		$558.72	$750.52	$1,438.50