Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,781.96 / $1,781.96 / $1,781.96	Facility		$1,781.96	$1,781.96	$1,781.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,119.91 / $1,603.76 / $2,102.05	Professional		$1,119.91	$1,603.76	$2,102.05
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,639.00 / $4,802.97 / $4,802.97	Facility		$2,639.00	$4,802.97	$4,802.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,454.27 / $2,454.28 / $3,562.65	Professional		$2,454.27	$2,454.28	$3,562.65
CareSource Facility/Professional Facility Modifier Low / Median / High Price $186.05 / $1,395.34 / $5,647.48	Facility		$186.05	$1,395.34	$5,647.48
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,217.64 / $2,217.64 / $8,012.80	Facility		$2,217.64	$2,217.64	$8,012.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,074.13 / $3,059.25 / $3,824.06	Professional		$2,074.13	$3,059.25	$3,824.06
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,613.67 / $2,017.09 / $3,166.81	Facility		$1,613.67	$2,017.09	$3,166.81
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,898.44 / $1,898.44 / $3,166.81	Professional		$1,898.44	$1,898.44	$3,166.81
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,613.67 / $3,207.53 / $12,404.85	Facility		$1,613.67	$3,207.53	$12,404.85
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,103.39 / $1,544.75 / $3,310.17	Professional		$1,103.39	$1,544.75	$3,310.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $2.54 / $55.00 / $1,571.92	Professional		$2.54	$55.00	$1,571.92
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,613.67 / $2,639.01 / $3,166.81	Facility		$1,613.67	$2,639.01	$3,166.81
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,898.44 / $1,898.44 / $3,166.81	Professional		$1,898.44	$1,898.44	$3,166.81
Quartz Facility/Professional Professional Modifier Low / Median / High Price $348.35 / $643.66 / $835.75	Professional		$348.35	$643.66	$835.75
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,217.64 / $5,124.28 / $12,404.85	Facility		$2,217.64	$5,124.28	$12,404.85
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,074.13 / $2,217.64 / $2,217.64	Professional		$2,074.13	$2,217.64	$2,217.64
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,748.37 / $2,748.37 / $2,748.37	Professional		$2,748.37	$2,748.37	$2,748.37
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,748.37 / $2,748.37 / $2,748.37	Professional		$2,748.37	$2,748.37	$2,748.37
United Facility/Professional Professional Modifier Low / Median / High Price $1,024.85 / $1,544.75 / $3,310.17	Professional		$1,024.85	$1,544.75	$3,310.17