Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,700.00 / $1,700.00 / $1,700.00	Facility		$1,700.00	$1,700.00	$1,700.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,059.50 / $1,513.44 / $1,988.58	Professional		$1,059.50	$1,513.44	$1,988.58
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,479.19 / $4,512.14 / $4,512.14	Facility		$2,479.19	$4,512.14	$4,512.14
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,305.66 / $2,305.67 / $3,346.96	Professional		$2,305.66	$2,305.67	$3,346.96
CareSource Facility/Professional Facility Modifier Low / Median / High Price $174.78 / $1,310.86 / $5,305.55	Facility		$174.78	$1,310.86	$5,305.55
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,772.06 / $1,772.06 / $6,525.01	Facility		$1,772.06	$1,772.06	$6,525.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,772.06 / $2,831.25 / $3,539.06	Professional		$1,772.06	$2,831.25	$3,539.06
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,603.89 / $2,004.86 / $2,975.08	Facility		$1,603.89	$2,004.86	$2,975.08
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,886.93 / $1,886.93 / $2,975.08	Professional		$1,886.93	$1,886.93	$2,975.08
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,603.89 / $3,060.00 / $11,540.27	Facility		$1,603.89	$3,060.00	$11,540.27
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,075.76 / $1,508.42 / $3,050.82	Professional		$1,075.76	$1,508.42	$3,050.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $4.66 / $55.00 / $1,912.89	Professional		$4.66	$55.00	$1,912.89
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,603.89 / $2,479.23 / $2,975.08	Facility		$1,603.89	$2,479.23	$2,975.08
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,886.93 / $1,886.93 / $2,975.08	Professional		$1,886.93	$1,886.93	$2,975.08
Quartz Facility/Professional Professional Modifier Low / Median / High Price $327.25 / $544.27 / $706.70	Professional		$327.25	$544.27	$706.70
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,772.06 / $4,814.04 / $11,540.27	Facility		$1,772.06	$4,814.04	$11,540.27
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,772.06 / $1,772.06 / $2,111.63	Professional		$1,772.06	$1,772.06	$2,111.63
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,761.56 / $2,761.56 / $2,761.56	Professional		$2,761.56	$2,761.56	$2,761.56
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,761.56 / $2,761.56 / $2,761.56	Professional		$2,761.56	$2,761.56	$2,761.56
United Facility/Professional Facility Modifier Low / Median / High Price $109.53 / $904.85 / $1,516.82	Facility		$109.53	$904.85	$1,516.82
United Facility/Professional Professional Modifier Low / Median / High Price $1,013.61 / $1,419.05 / $2,761.56	Professional		$1,013.61	$1,419.05	$2,761.56