Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,210.00 / $1,210.00 / $1,210.00	Facility		$1,210.00	$1,210.00	$1,210.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,210.00 / $1,238.58 / $2,352.30	Professional		$1,210.00	$1,238.58	$2,352.30
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,398.60 / $2,638.46 / $4,365.45	Facility		$2,398.60	$2,638.46	$4,365.45
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,158.73 / $2,230.69 / $2,950.27	Professional		$2,158.73	$2,230.69	$2,950.27
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,725.54 / $5,133.00 / $5,133.00	Facility		$1,725.54	$5,133.00	$5,133.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,703.99 / $4,958.71 / $10,012.48	Facility		$1,703.99	$4,958.71	$10,012.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,243.91 / $3,475.78 / $4,539.54	Professional		$1,243.91	$3,475.78	$4,539.54
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $733.56 / $1,815.00 / $2,758.39	Facility		$733.56	$1,815.00	$2,758.39
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,373.37 / $2,398.60 / $3,036.84	Professional		$1,373.37	$2,398.60	$3,036.84
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,210.00 / $2,398.60 / $11,712.03	Facility		$1,210.00	$2,398.60	$11,712.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,080.45 / $1,369.32 / $2,707.96	Professional		$1,080.45	$1,369.32	$2,707.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,449.87	Professional		$50.00	$70.00	$1,449.87
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $733.56 / $1,815.00 / $2,758.39	Facility		$733.56	$1,815.00	$2,758.39
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,373.37 / $2,398.60 / $3,036.84	Professional		$1,373.37	$2,398.60	$3,036.84
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,398.60 / $3,691.33 / $6,818.13	Professional		$2,398.60	$3,691.33	$6,818.13
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,703.99 / $4,684.76 / $11,712.03	Facility		$1,703.99	$4,684.76	$11,712.03
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,243.91 / $1,703.99 / $14,576.83	Professional		$1,243.91	$1,703.99	$14,576.83
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,398.60 / $2,398.60 / $2,398.60	Professional		$2,398.60	$2,398.60	$2,398.60
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,398.60 / $2,398.60 / $2,398.60	Professional		$2,398.60	$2,398.60	$2,398.60
United Facility/Professional Facility Modifier Low / Median / High Price $1,520.62 / $1,520.62 / $1,520.62	Facility		$1,520.62	$1,520.62	$1,520.62
United Facility/Professional Professional Modifier Low / Median / High Price $889.70 / $1,277.00 / $2,293.54	Professional		$889.70	$1,277.00	$2,293.54