Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,232.49 / $1,232.49 / $1,232.49	Facility		$1,232.49	$1,232.49	$1,232.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,086.19 / $1,232.49 / $2,062.86	Professional		$1,086.19	$1,232.49	$2,062.86
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,443.17 / $2,687.50 / $4,446.59	Facility		$2,443.17	$2,687.50	$4,446.59
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,198.86 / $2,272.16 / $3,005.11	Professional		$2,198.86	$2,272.16	$3,005.11
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,757.62 / $5,228.41 / $5,228.41	Facility		$1,757.62	$5,228.41	$5,228.41
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,499.97 / $5,051.57 / $10,198.62	Facility		$1,499.97	$5,051.57	$10,198.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,094.98 / $3,540.47 / $4,623.91	Professional		$1,094.98	$3,540.47	$4,623.91
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $736.66 / $1,848.74 / $2,809.66	Facility		$736.66	$1,848.74	$2,809.66
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,398.92 / $2,443.17 / $3,049.64	Professional		$1,398.92	$2,443.17	$3,049.64
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,232.49 / $2,443.17 / $12,090.55	Facility		$1,232.49	$2,443.17	$12,090.55
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,055.02 / $1,331.25 / $2,758.34	Professional		$1,055.02	$1,331.25	$2,758.34
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,215.78	Professional		$50.00	$70.00	$1,215.78
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $736.66 / $1,848.74 / $2,809.66	Facility		$736.66	$1,848.74	$2,809.66
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,398.92 / $2,443.17 / $3,049.64	Professional		$1,398.92	$2,443.17	$3,049.64
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,443.17 / $3,759.98 / $6,846.24	Professional		$2,443.17	$3,759.98	$6,846.24
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,499.97 / $4,771.84 / $12,090.55	Facility		$1,499.97	$4,771.84	$12,090.55
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,094.98 / $1,499.97 / $16,368.35	Professional		$1,094.98	$1,499.97	$16,368.35
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,443.17 / $2,443.17 / $2,443.17	Professional		$2,443.17	$2,443.17	$2,443.17
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,443.17 / $2,443.17 / $2,443.17	Professional		$2,443.17	$2,443.17	$2,443.17
United Facility/Professional Professional Modifier Low / Median / High Price $893.45 / $1,218.88 / $2,166.17	Professional		$893.45	$1,218.88	$2,166.17