Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,624.62 / $1,624.62 / $1,624.62	Facility		$1,624.62	$1,624.62	$1,624.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,436.31 / $1,624.62 / $2,727.80	Professional		$1,436.31	$1,624.62	$2,727.80
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,220.50 / $3,542.55 / $5,861.31	Facility		$3,220.50	$3,542.55	$5,861.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,785.41 / $2,995.07 / $3,961.21	Professional		$2,785.41	$2,995.07	$3,961.21
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,316.82 / $6,891.87 / $6,891.87	Facility		$2,316.82	$6,891.87	$6,891.87
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,815.81 / $6,657.57 / $13,442.81	Facility		$1,815.81	$6,657.57	$13,442.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,325.54 / $4,666.88 / $6,095.05	Professional		$1,325.54	$4,666.88	$6,095.05
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $935.93 / $2,436.92 / $3,703.58	Facility		$935.93	$2,436.92	$3,703.58
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,843.95 / $3,220.50 / $3,874.60	Professional		$1,843.95	$3,220.50	$3,874.60
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,620.13 / $3,220.50 / $15,138.02	Facility		$1,620.13	$3,220.50	$15,138.02
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,340.41 / $1,691.37 / $3,624.36	Professional		$1,340.41	$1,691.37	$3,624.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,997.14	Professional		$50.00	$70.00	$1,997.14
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $935.93 / $2,436.92 / $3,703.58	Facility		$935.93	$2,436.92	$3,703.58
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,843.95 / $3,220.50 / $3,874.60	Professional		$1,843.95	$3,220.50	$3,874.60
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,220.50 / $4,956.22 / $8,699.07	Professional		$3,220.50	$4,956.22	$8,699.07
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,815.81 / $6,290.04 / $15,138.02	Facility		$1,815.81	$6,290.04	$15,138.02
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,325.54 / $1,815.81 / $18,962.96	Professional		$1,325.54	$1,815.81	$18,962.96
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,220.50 / $3,220.50 / $3,220.50	Professional		$3,220.50	$3,220.50	$3,220.50
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,571.44 / $3,220.50 / $3,220.50	Professional		$2,571.44	$3,220.50	$3,220.50
United Facility/Professional Professional Modifier Low / Median / High Price $1,208.11 / $1,691.37 / $3,506.73	Professional		$1,208.11	$1,691.37	$3,506.73