Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $681.09 / $681.09 / $681.09	Facility		$681.09	$681.09	$681.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $469.42 / $681.09 / $1,130.85	Professional		$469.42	$681.09	$1,130.85
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,350.12 / $1,485.13 / $2,457.21	Facility		$1,350.12	$1,485.13	$2,457.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,167.71 / $1,255.60 / $1,660.64	Professional		$1,167.71	$1,255.60	$1,660.64
CareSource Facility/Professional Facility Modifier Low / Median / High Price $971.27 / $2,889.26 / $2,889.26	Facility		$971.27	$2,889.26	$2,889.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $957.73 / $2,791.72 / $5,636.04	Facility		$957.73	$2,791.72	$5,636.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $699.14 / $1,956.56 / $2,555.21	Professional		$699.14	$1,956.56	$2,555.21
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $352.30 / $1,021.64 / $1,552.64	Facility		$352.30	$1,021.64	$1,552.64
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $773.05 / $1,190.91 / $1,620.14	Professional		$773.05	$1,190.91	$1,620.14
Medica Facility/Professional Facility Modifier Low / Median / High Price $609.84 / $1,350.12 / $5,705.72	Facility		$609.84	$1,350.12	$5,705.72
Medica Facility/Professional Professional Modifier Low / Median / High Price $605.76 / $822.02 / $1,470.12	Professional		$605.76	$822.02	$1,470.12
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $787.64	Professional		$50.00	$70.00	$787.64
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $352.30 / $1,021.64 / $1,552.64	Facility		$352.30	$1,021.64	$1,552.64
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $773.05 / $1,190.91 / $1,620.14	Professional		$773.05	$1,190.91	$1,620.14
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,350.12 / $2,077.80 / $3,274.07	Professional		$1,350.12	$2,077.80	$3,274.07
Quartz Facility/Professional Facility Modifier Low / Median / High Price $957.73 / $2,636.96 / $5,705.72	Facility		$957.73	$2,636.96	$5,705.72
Quartz Facility/Professional Professional Modifier Low / Median / High Price $699.14 / $957.73 / $5,933.16	Professional		$699.14	$957.73	$5,933.16
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,350.12 / $1,350.12 / $1,350.12	Professional		$1,350.12	$1,350.12	$1,350.12
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,350.12 / $1,350.12 / $1,350.12	Professional		$1,350.12	$1,350.12	$1,350.12
United Facility/Professional Facility Modifier Low / Median / High Price $595.23 / $595.23 / $595.23	Facility		$595.23	$595.23	$595.23
United Facility/Professional Professional Modifier Low / Median / High Price $454.76 / $821.20 / $1,350.12	Professional		$454.76	$821.20	$1,350.12