Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $896.00 / $896.00 / $896.00	Facility		$896.00	$896.00	$896.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $858.50 / $912.91 / $1,234.11	Professional		$858.50	$912.91	$1,234.11
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,776.15 / $1,953.77 / $3,232.59	Facility		$1,776.15	$1,953.77	$3,232.59
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,598.53 / $1,651.82 / $2,184.66	Professional		$1,598.53	$1,651.82	$2,184.66
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,277.77 / $3,800.96 / $3,800.96	Facility		$1,277.77	$3,800.96	$3,800.96
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,037.25 / $3,921.18 / $7,413.49	Facility		$1,037.25	$3,921.18	$7,413.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $757.19 / $2,573.91 / $3,361.50	Professional		$757.19	$2,573.91	$3,361.50
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $896.00 / $1,420.92 / $2,042.57	Facility		$896.00	$1,420.92	$2,042.57
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,776.15 / $2,131.38 / $2,213.30	Professional		$1,776.15	$2,131.38	$2,213.30
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,083.95 / $1,776.15 / $8,839.16	Facility		$1,083.95	$1,776.15	$8,839.16
Medica Facility/Professional Professional Modifier Low / Median / High Price $800.08 / $985.07 / $2,017.70	Professional		$800.08	$985.07	$2,017.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $65.00 / $926.80	Professional		$50.00	$65.00	$926.80
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $896.00 / $1,420.92 / $2,042.57	Facility		$896.00	$1,420.92	$2,042.57
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,776.15 / $2,131.38 / $2,213.30	Professional		$1,776.15	$2,131.38	$2,213.30
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,776.15 / $2,733.47 / $4,969.32	Professional		$1,776.15	$2,733.47	$4,969.32
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,037.25 / $3,469.04 / $8,839.16	Facility		$1,037.25	$3,469.04	$8,839.16
Quartz Facility/Professional Professional Modifier Low / Median / High Price $757.19 / $1,037.25 / $10,623.84	Professional		$757.19	$1,037.25	$10,623.84
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,776.15 / $1,776.15 / $1,776.15	Professional		$1,776.15	$1,776.15	$1,776.15
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,776.15 / $1,776.15 / $1,776.15	Professional		$1,776.15	$1,776.15	$1,776.15
United Facility/Professional Professional Modifier Low / Median / High Price $690.12 / $957.11 / $1,776.15	Professional		$690.12	$957.11	$1,776.15