Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $961.31 / $961.31 / $961.31	Facility		$961.31	$961.31	$961.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $719.01 / $961.31 / $1,596.14	Professional		$719.01	$961.31	$1,596.14
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,905.61 / $2,096.17 / $3,468.21	Facility		$1,905.61	$2,096.17	$3,468.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,772.22 / $1,772.22 / $2,343.90	Professional		$1,772.22	$1,772.22	$2,343.90
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,370.89 / $4,078.01 / $4,078.01	Facility		$1,370.89	$4,078.01	$4,078.01
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,232.72 / $3,939.94 / $7,953.72	Facility		$1,232.72	$3,939.94	$7,953.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $899.89 / $2,761.41 / $3,606.53	Professional		$899.89	$2,761.41	$3,606.53
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $555.90 / $1,441.97 / $2,191.44	Facility		$555.90	$1,441.97	$2,191.44
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,091.10 / $1,905.61 / $2,299.94	Professional		$1,091.10	$1,905.61	$2,299.94
Medica Facility/Professional Facility Modifier Low / Median / High Price $961.31 / $1,905.61 / $9,329.16	Facility		$961.31	$1,905.61	$9,329.16
Medica Facility/Professional Professional Modifier Low / Median / High Price $872.66 / $1,273.28 / $2,151.41	Professional		$872.66	$1,273.28	$2,151.41
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,164.80	Professional		$50.00	$70.00	$1,164.80
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $555.90 / $1,470.80 / $2,191.44	Facility		$555.90	$1,470.80	$2,191.44
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,091.10 / $1,905.61 / $2,299.94	Professional		$1,091.10	$1,905.61	$2,299.94
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,905.61 / $2,932.66 / $5,167.05	Professional		$1,905.61	$2,932.66	$5,167.05
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,232.72 / $3,721.90 / $9,329.16	Facility		$1,232.72	$3,721.90	$9,329.16
Quartz Facility/Professional Professional Modifier Low / Median / High Price $899.89 / $1,232.72 / $11,391.63	Professional		$899.89	$1,232.72	$11,391.63
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,905.61 / $1,905.61 / $1,905.61	Professional		$1,905.61	$1,905.61	$1,905.61
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,905.61 / $1,905.61 / $1,905.61	Professional		$1,905.61	$1,905.61	$1,905.61
United Facility/Professional Professional Modifier Low / Median / High Price $759.17 / $1,148.11 / $1,689.55	Professional		$759.17	$1,148.11	$1,689.55