Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $952.16 / $952.16 / $952.16	Facility		$952.16	$952.16	$952.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $952.16 / $1,049.09 / $2,050.05	Professional		$952.16	$1,049.09	$2,050.05
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,887.48 / $2,076.23 / $3,435.21	Facility		$1,887.48	$2,076.23	$3,435.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,755.36 / $1,755.36 / $2,321.60	Professional		$1,755.36	$1,755.36	$2,321.60
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,357.85 / $4,039.21 / $4,039.21	Facility		$1,357.85	$4,039.21	$4,039.21
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,179.41 / $3,902.42 / $7,878.15	Facility		$1,179.41	$3,902.42	$7,878.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $860.97 / $2,735.16 / $3,572.20	Professional		$860.97	$2,735.16	$3,572.20
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $607.91 / $1,428.24 / $2,170.60	Facility		$607.91	$1,428.24	$2,170.60
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,080.73 / $1,887.48 / $2,264.98	Professional		$1,080.73	$1,887.48	$2,264.98
Medica Facility/Professional Facility Modifier Low / Median / High Price $952.16 / $1,981.85 / $10,013.70	Facility		$952.16	$1,981.85	$10,013.70
Medica Facility/Professional Professional Modifier Low / Median / High Price $855.00 / $1,098.58 / $2,055.23	Professional		$855.00	$1,098.58	$2,055.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,270.80	Professional		$50.00	$70.00	$1,270.80
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $607.91 / $1,428.24 / $2,170.60	Facility		$607.91	$1,428.24	$2,170.60
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,080.73 / $1,887.48 / $2,264.98	Professional		$1,080.73	$1,887.48	$2,264.98
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,887.48 / $2,904.76 / $5,649.83	Professional		$1,887.48	$2,904.76	$5,649.83
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,179.41 / $3,686.48 / $10,013.70	Facility		$1,179.41	$3,686.48	$10,013.70
Quartz Facility/Professional Professional Modifier Low / Median / High Price $860.97 / $1,179.41 / $12,532.82	Professional		$860.97	$1,179.41	$12,532.82
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,887.48 / $1,887.48 / $1,887.48	Professional		$1,887.48	$1,887.48	$1,887.48
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,507.10 / $1,887.48 / $1,887.48	Professional		$1,507.10	$1,887.48	$1,887.48
United Facility/Professional Professional Modifier Low / Median / High Price $737.30 / $954.30 / $1,804.81	Professional		$737.30	$954.30	$1,804.81