Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $915.06 / $915.06 / $915.06	Facility		$915.06	$915.06	$915.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $618.85 / $915.06 / $1,519.35	Professional		$618.85	$915.06	$1,519.35
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,813.93 / $1,995.32 / $3,301.35	Facility		$1,813.93	$1,995.32	$3,301.35
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,568.86 / $1,686.95 / $2,231.13	Professional		$1,568.86	$1,686.95	$2,231.13
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,304.94 / $3,881.81 / $3,881.81	Facility		$1,304.94	$3,881.81	$3,881.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,232.20 / $3,750.45 / $7,571.64	Facility		$1,232.20	$3,750.45	$7,571.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $899.51 / $2,628.75 / $3,433.01	Professional		$899.51	$2,628.75	$3,433.01
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $478.20 / $1,372.59 / $2,086.02	Facility		$478.20	$1,372.59	$2,086.02
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,038.59 / $1,692.97 / $2,176.71	Professional		$1,038.59	$1,692.97	$2,176.71
Medica Facility/Professional Facility Modifier Low / Median / High Price $827.78 / $1,813.93 / $7,733.84	Facility		$827.78	$1,813.93	$7,733.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $817.08 / $1,115.80 / $1,975.15	Professional		$817.08	$1,115.80	$1,975.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,058.18	Professional		$50.00	$70.00	$1,058.18
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $478.20 / $1,372.59 / $2,086.02	Facility		$478.20	$1,372.59	$2,086.02
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,038.59 / $1,692.97 / $2,176.71	Professional		$1,038.59	$1,692.97	$2,176.71
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,813.93 / $2,791.58 / $4,444.38	Professional		$1,813.93	$2,791.58	$4,444.38
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,232.20 / $3,542.84 / $7,733.84	Facility		$1,232.20	$3,542.84	$7,733.84
Quartz Facility/Professional Professional Modifier Low / Median / High Price $899.51 / $1,232.20 / $8,380.20	Professional		$899.51	$1,232.20	$8,380.20
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,813.93 / $1,813.93 / $1,813.93	Professional		$1,813.93	$1,813.93	$1,813.93
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,813.93 / $1,813.93 / $1,813.93	Professional		$1,813.93	$1,813.93	$1,813.93
United Facility/Professional Professional Modifier Low / Median / High Price $617.28 / $987.64 / $1,801.91	Professional		$617.28	$987.64	$1,801.91