Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $974.52 / $974.52 / $974.52	Facility		$974.52	$974.52	$974.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $917.40 / $974.52 / $1,742.30	Professional		$917.40	$974.52	$1,742.30
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,931.80 / $2,124.98 / $3,515.88	Facility		$1,931.80	$2,124.98	$3,515.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,796.57 / $1,796.57 / $2,376.11	Professional		$1,796.57	$1,796.57	$2,376.11
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,389.74 / $4,134.05 / $4,134.05	Facility		$1,389.74	$4,134.05	$4,134.05
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,207.09 / $3,993.42 / $8,062.89	Facility		$1,207.09	$3,993.42	$8,062.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $881.18 / $2,799.38 / $3,656.10	Professional		$881.18	$2,799.38	$3,656.10
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $622.17 / $1,461.78 / $2,221.57	Facility		$622.17	$1,461.78	$2,221.57
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,106.09 / $1,931.80 / $2,424.30	Professional		$1,106.09	$1,931.80	$2,424.30
Medica Facility/Professional Facility Modifier Low / Median / High Price $974.52 / $2,028.39 / $9,986.98	Facility		$974.52	$2,028.39	$9,986.98
Medica Facility/Professional Professional Modifier Low / Median / High Price $875.08 / $1,124.38 / $2,180.96	Professional		$875.08	$1,124.38	$2,180.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,008.57	Professional		$50.00	$70.00	$1,008.57
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $622.17 / $1,461.78 / $2,221.57	Facility		$622.17	$1,461.78	$2,221.57
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,106.09 / $1,931.80 / $2,424.30	Professional		$1,106.09	$1,931.80	$2,424.30
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,931.80 / $2,972.97 / $5,782.32	Professional		$1,931.80	$2,972.97	$5,782.32
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,207.09 / $3,773.06 / $9,986.98	Facility		$1,207.09	$3,773.06	$9,986.98
Quartz Facility/Professional Professional Modifier Low / Median / High Price $881.18 / $1,207.09 / $12,749.91	Professional		$881.18	$1,207.09	$12,749.91
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,931.80 / $1,931.80 / $1,931.80	Professional		$1,931.80	$1,931.80	$1,931.80
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,931.80 / $1,931.80 / $1,931.80	Professional		$1,931.80	$1,931.80	$1,931.80
United Facility/Professional Professional Modifier Low / Median / High Price $754.61 / $965.32 / $1,805.34	Professional		$754.61	$965.32	$1,805.34