Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $902.61 / $902.61 / $902.61	Facility		$902.61	$902.61	$902.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $643.02 / $902.61 / $1,498.68	Professional		$643.02	$902.61	$1,498.68
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,789.26 / $1,968.19 / $3,256.45	Facility		$1,789.26	$1,968.19	$3,256.45
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,610.33 / $1,664.01 / $2,200.78	Professional		$1,610.33	$1,664.01	$2,200.78
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,287.17 / $3,829.02 / $3,829.02	Facility		$1,287.17	$3,829.02	$3,829.02
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,260.83 / $3,950.22 / $7,468.07	Facility		$1,260.83	$3,950.22	$7,468.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $920.41 / $2,634.14 / $3,386.30	Professional		$920.41	$2,634.14	$3,386.30
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $497.15 / $1,353.92 / $2,057.65	Facility		$497.15	$1,353.92	$2,057.65
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,024.47 / $1,789.26 / $2,147.11	Professional		$1,024.47	$1,789.26	$2,147.11
Medica Facility/Professional Facility Modifier Low / Median / High Price $860.58 / $1,789.26 / $8,127.52	Facility		$860.58	$1,789.26	$8,127.52
Medica Facility/Professional Professional Modifier Low / Median / High Price $815.90 / $1,160.02 / $1,948.28	Professional		$815.90	$1,160.02	$1,948.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $997.53	Professional		$50.00	$70.00	$997.53
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $497.15 / $1,353.92 / $2,057.65	Facility		$497.15	$1,353.92	$2,057.65
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,024.47 / $1,789.26 / $2,147.11	Professional		$1,024.47	$1,789.26	$2,147.11
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,789.26 / $2,753.59 / $4,621.03	Professional		$1,789.26	$2,753.59	$4,621.03
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,260.83 / $3,494.64 / $8,127.52	Facility		$1,260.83	$3,494.64	$8,127.52
Quartz Facility/Professional Professional Modifier Low / Median / High Price $920.41 / $1,260.83 / $9,493.87	Professional		$920.41	$1,260.83	$9,493.87
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,789.26 / $1,789.26 / $1,789.26	Professional		$1,789.26	$1,789.26	$1,789.26
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,789.26 / $1,789.26 / $1,789.26	Professional		$1,789.26	$1,789.26	$1,789.26
United Facility/Professional Professional Modifier Low / Median / High Price $641.74 / $1,073.56 / $1,586.38	Professional		$641.74	$1,073.56	$1,586.38