Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,277.98 / $1,277.98 / $1,277.98	Facility		$1,277.98	$1,277.98	$1,277.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,161.91 / $1,277.98 / $2,206.67	Professional		$1,161.91	$1,277.98	$2,206.67
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,533.35 / $2,786.69 / $4,610.70	Facility		$2,533.35	$2,786.69	$4,610.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,356.02 / $2,356.02 / $3,116.02	Professional		$2,356.02	$2,356.02	$3,116.02
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,822.49 / $5,421.37 / $5,421.37	Facility		$1,822.49	$5,421.37	$5,421.37
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,638.80 / $5,237.30 / $10,573.71	Facility		$1,638.80	$5,237.30	$10,573.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,196.32 / $4,219.20 / $4,794.55	Professional		$1,196.32	$4,219.20	$4,794.55
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $783.77 / $1,916.97 / $2,913.35	Facility		$783.77	$1,916.97	$2,913.35
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,450.54 / $2,533.35 / $3,054.37	Professional		$1,450.54	$2,533.35	$3,054.37
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,277.98 / $2,572.48 / $12,562.85	Facility		$1,277.98	$2,572.48	$12,562.85
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,122.50 / $1,416.40 / $2,860.11	Professional		$1,122.50	$1,416.40	$2,860.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $970.09	Professional		$50.00	$70.00	$970.09
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $783.77 / $1,916.97 / $2,913.35	Facility		$783.77	$1,916.97	$2,913.35
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,450.54 / $2,533.35 / $3,054.37	Professional		$1,450.54	$2,533.35	$3,054.37
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,533.35 / $3,898.75 / $7,284.85	Professional		$2,533.35	$3,898.75	$7,284.85
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,638.80 / $4,947.93 / $12,562.85	Facility		$1,638.80	$4,947.93	$12,562.85
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,196.32 / $1,638.80 / $15,057.95	Professional		$1,196.32	$1,638.80	$15,057.95
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,533.35 / $2,533.35 / $2,533.35	Professional		$2,533.35	$2,533.35	$2,533.35
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,533.35 / $2,533.35 / $2,533.35	Professional		$2,533.35	$2,533.35	$2,533.35
United Facility/Professional Facility Modifier Low / Median / High Price $1.94 / $1,278.89 / $1,376.73	Facility		$1.94	$1,278.89	$1,376.73
United Facility/Professional Professional Modifier Low / Median / High Price $1,009.26 / $1,263.85 / $2,422.41	Professional		$1,009.26	$1,263.85	$2,422.41