Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $923.43 / $923.43 / $923.43	Facility		$923.43	$923.43	$923.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $766.68 / $923.43 / $1,547.10	Professional		$766.68	$923.43	$1,547.10
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,830.52 / $2,013.57 / $3,331.55	Facility		$1,830.52	$2,013.57	$3,331.55
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,630.81 / $1,702.38 / $2,251.53	Professional		$1,630.81	$1,702.38	$2,251.53
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,316.88 / $3,917.31 / $3,917.31	Facility		$1,316.88	$3,917.31	$3,917.31
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,022.07 / $4,041.40 / $7,640.22	Facility		$1,022.07	$4,041.40	$7,640.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $868.76 / $2,652.66 / $3,464.41	Professional		$868.76	$2,652.66	$3,464.41
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $923.43 / $1,457.27 / $2,105.10	Facility		$923.43	$1,457.27	$2,105.10
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,786.65 / $1,830.52 / $2,196.62	Professional		$1,786.65	$1,830.52	$2,196.62
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,198.01 / $1,830.52 / $7,863.62	Facility		$1,198.01	$1,830.52	$7,863.62
Medica Facility/Professional Professional Modifier Low / Median / High Price $840.23 / $1,227.99 / $2,003.75	Professional		$840.23	$1,227.99	$2,003.75
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,336.90	Professional		$50.00	$70.00	$1,336.90
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $923.43 / $1,464.42 / $2,105.10	Facility		$923.43	$1,464.42	$2,105.10
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,786.65 / $1,830.52 / $2,196.62	Professional		$1,786.65	$1,830.52	$2,196.62
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,830.52 / $2,817.12 / $4,896.05	Professional		$1,830.52	$2,817.12	$4,896.05
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,022.07 / $3,575.24 / $7,863.62	Facility		$1,022.07	$3,575.24	$7,863.62
Quartz Facility/Professional Professional Modifier Low / Median / High Price $868.76 / $1,022.07 / $9,234.45	Professional		$868.76	$1,022.07	$9,234.45
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,830.52 / $1,830.52 / $1,830.52	Professional		$1,830.52	$1,830.52	$1,830.52
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,830.52 / $1,830.52 / $1,830.52	Professional		$1,830.52	$1,830.52	$1,830.52
United Facility/Professional Professional Modifier Low / Median / High Price $680.02 / $1,088.03 / $1,830.52	Professional		$680.02	$1,088.03	$1,830.52