Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $896.62 / $896.62 / $896.62	Facility		$896.62	$896.62	$896.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $803.60 / $896.62 / $1,526.17	Professional		$803.60	$896.62	$1,526.17
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,777.39 / $1,955.13 / $3,234.85	Facility		$1,777.39	$1,955.13	$3,234.85
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,652.97 / $1,652.97 / $2,186.17	Professional		$1,652.97	$1,652.97	$2,186.17
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,278.64 / $3,803.61 / $3,803.61	Facility		$1,278.64	$3,803.61	$3,803.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,149.77 / $3,674.46 / $7,419.09	Facility		$1,149.77	$3,674.46	$7,419.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $839.33 / $2,575.78 / $3,363.85	Professional		$839.33	$2,575.78	$3,363.85
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $478.13 / $1,344.93 / $2,044.00	Facility		$478.13	$1,344.93	$2,044.00
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,017.69 / $1,777.39 / $2,132.87	Professional		$1,017.69	$1,777.39	$2,132.87
Medica Facility/Professional Facility Modifier Low / Median / High Price $827.66 / $1,777.39 / $7,860.20	Facility		$827.66	$1,777.39	$7,860.20
Medica Facility/Professional Professional Modifier Low / Median / High Price $734.00 / $886.72 / $1,935.35	Professional		$734.00	$886.72	$1,935.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $757.09	Professional		$50.00	$70.00	$757.09
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $478.13 / $1,344.93 / $2,044.00	Facility		$478.13	$1,344.93	$2,044.00
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,017.69 / $1,777.39 / $2,132.87	Professional		$1,017.69	$1,777.39	$2,132.87
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,777.39 / $2,735.34 / $4,443.38	Professional		$1,777.39	$2,735.34	$4,443.38
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,149.77 / $3,471.46 / $7,860.20	Facility		$1,149.77	$3,471.46	$7,860.20
Quartz Facility/Professional Professional Modifier Low / Median / High Price $839.33 / $1,149.77 / $13,164.93	Professional		$839.33	$1,149.77	$13,164.93
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,777.39 / $1,777.39 / $1,777.39	Professional		$1,777.39	$1,777.39	$1,777.39
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,777.39 / $1,777.39 / $1,777.39	Professional		$1,777.39	$1,777.39	$1,777.39
United Facility/Professional Professional Modifier Low / Median / High Price $617.17 / $886.72 / $1,777.39	Professional		$617.17	$886.72	$1,777.39