Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,862.90 / $3,528.41 / $4,156.12	Facility		$1,862.90	$3,528.41	$4,156.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,808.65 / $1,862.90 / $3,922.01	Professional		$1,808.65	$1,862.90	$3,922.01
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,260.81 / $3,345.98 / $4,033.27	Facility		$2,260.81	$3,345.98	$4,033.27
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,808.65 / $1,808.65 / $2,296.98	Professional		$1,808.65	$1,808.65	$2,296.98
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,476.21 / $2,476.21 / $2,893.84	Facility		$2,476.21	$2,476.21	$2,893.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,808.65 / $4,406.03 / $6,298.13	Facility		$1,808.65	$4,406.03	$6,298.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,808.65 / $2,819.52 / $3,204.00	Professional		$1,808.65	$2,819.52	$3,204.00
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $960.28 / $1,808.65 / $1,809.44	Facility		$960.28	$1,808.65	$1,809.44
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $616.47 / $3,617.30 / $3,617.30	Professional		$616.47	$3,617.30	$3,617.30
Medica Facility/Professional Facility Modifier Low / Median / High Price $960.28 / $1,809.44 / $1,809.44	Facility		$960.28	$1,809.44	$1,809.44
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,809.44 / $2,026.57 / $3,617.30	Professional		$1,809.44	$2,026.57	$3,617.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $65.00 / $85.00 / $1,812.01	Professional		$65.00	$85.00	$1,812.01
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $960.28 / $1,808.65 / $1,809.44	Facility		$960.28	$1,808.65	$1,809.44
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $616.47 / $3,617.30 / $3,617.30	Professional		$616.47	$3,617.30	$3,617.30
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,808.65 / $2,017.20 / $5,608.00	Professional		$1,808.65	$2,017.20	$5,608.00
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,808.65 / $1,808.65 / $9,060.04	Facility		$1,808.65	$1,808.65	$9,060.04
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,808.65 / $1,808.65 / $1,808.65	Professional		$1,808.65	$1,808.65	$1,808.65
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,411.44 / $2,539.34 / $2,539.34	Professional		$1,411.44	$2,539.34	$2,539.34
United Facility/Professional Professional Modifier Low / Median / High Price $1,808.65 / $2,025.69 / $2,278.90	Professional		$1,808.65	$2,025.69	$2,278.90