Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,105.54 / $2,105.54 / $2,105.54	Facility		$2,105.54	$2,105.54	$2,105.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,329.61 / $1,894.98 / $2,346.80	Professional		$1,329.61	$1,894.98	$2,346.80
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,976.40 / $5,417.05 / $5,417.05	Facility		$2,976.40	$5,417.05	$5,417.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,768.05 / $2,938.98 / $4,152.07	Professional		$2,768.05	$2,938.98	$4,152.07
CareSource Facility/Professional Facility Modifier Low / Median / High Price $214.12 / $1,798.01 / $6,762.81	Facility		$214.12	$1,798.01	$6,762.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,786.79 / $1,786.79 / $8,493.06	Facility		$1,786.79	$1,786.79	$8,493.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,786.79 / $3,663.75 / $4,579.68	Professional		$1,786.79	$3,663.75	$4,579.68
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $865.13 / $2,105.54 / $3,789.97	Facility		$865.13	$2,105.54	$3,789.97
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,583.19 / $1,583.19 / $3,792.23	Professional		$1,583.19	$1,583.19	$3,792.23
Medica Facility/Professional Facility Modifier Low / Median / High Price $865.13 / $3,792.23 / $14,043.28	Facility		$865.13	$3,792.23	$14,043.28
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,239.02 / $1,576.58 / $3,519.76	Professional		$1,239.02	$1,576.58	$3,519.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $58.40 / $65.00	Professional		$50.00	$58.40	$65.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $865.13 / $2,105.54 / $3,789.97	Facility		$865.13	$2,105.54	$3,789.97
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,583.19 / $1,583.19 / $3,792.23	Professional		$1,583.19	$1,583.19	$3,792.23
Quartz Facility/Professional Professional Modifier Low / Median / High Price $392.88 / $621.57 / $807.07	Professional		$392.88	$621.57	$807.07
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,786.79 / $6,172.24 / $14,043.28	Facility		$1,786.79	$6,172.24	$14,043.28
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,786.79 / $1,786.79 / $2,273.92	Professional		$1,786.79	$1,786.79	$2,273.92
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,160.19 / $3,160.19 / $3,160.19	Professional		$3,160.19	$3,160.19	$3,160.19
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,160.19 / $3,160.19 / $3,160.19	Professional		$3,160.19	$3,160.19	$3,160.19
United Facility/Professional Professional Modifier Low / Median / High Price $1,116.75 / $1,576.58 / $3,160.19	Professional		$1,116.75	$1,576.58	$3,160.19