Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $812.55 / $812.55 / $812.55	Facility		$812.55	$812.55	$812.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $764.92 / $812.55 / $1,452.72	Professional		$764.92	$812.55	$1,452.72
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,610.72 / $1,771.79 / $2,931.51	Facility		$1,610.72	$1,771.79	$2,931.51
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,449.64 / $1,497.97 / $1,981.18	Professional		$1,449.64	$1,497.97	$1,981.18
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,158.75 / $3,446.94 / $3,446.94	Facility		$1,158.75	$3,446.94	$3,446.94
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,006.48 / $3,330.20 / $6,723.51	Facility		$1,006.48	$3,330.20	$6,723.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $734.73 / $2,682.60 / $3,048.41	Professional		$734.73	$2,682.60	$3,048.41
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $518.77 / $1,218.83 / $1,852.33	Facility		$518.77	$1,218.83	$1,852.33
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $922.26 / $1,610.72 / $1,932.86	Professional		$922.26	$1,610.72	$1,932.86
Medica Facility/Professional Facility Modifier Low / Median / High Price $812.55 / $1,610.72 / $8,399.94	Facility		$812.55	$1,610.72	$8,399.94
Medica Facility/Professional Professional Modifier Low / Median / High Price $729.64 / $937.50 / $1,818.48	Professional		$729.64	$937.50	$1,818.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $65.00 / $85.00	Professional		$50.00	$65.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $518.77 / $1,218.83 / $1,852.33	Facility		$518.77	$1,218.83	$1,852.33
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $922.26 / $1,610.72 / $1,932.86	Professional		$922.26	$1,610.72	$1,932.86
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,610.72 / $2,478.86 / $4,821.77	Professional		$1,610.72	$2,478.86	$4,821.77
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,006.48 / $3,145.94 / $8,399.94	Facility		$1,006.48	$3,145.94	$8,399.94
Quartz Facility/Professional Professional Modifier Low / Median / High Price $734.73 / $1,006.48 / $10,156.85	Professional		$734.73	$1,006.48	$10,156.85
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,610.72 / $1,610.72 / $1,610.72	Professional		$1,610.72	$1,610.72	$1,610.72
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,610.72 / $1,610.72 / $1,610.72	Professional		$1,610.72	$1,610.72	$1,610.72
United Facility/Professional Facility Modifier Low / Median / High Price $820.00 / $820.00 / $820.00	Facility		$820.00	$820.00	$820.00
United Facility/Professional Professional Modifier Low / Median / High Price $641.69 / $804.88 / $1,540.18	Professional		$641.69	$804.88	$1,540.18