Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,088.28 / $1,088.28 / $1,088.28	Facility		$1,088.28	$1,088.28	$1,088.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $882.48 / $1,088.28 / $1,675.99	Professional		$882.48	$1,088.28	$1,675.99
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,157.30 / $2,373.03 / $3,926.29	Facility		$2,157.30	$2,373.03	$3,926.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,006.29 / $2,006.29 / $2,653.47	Professional		$2,006.29	$2,006.29	$2,653.47
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,551.96 / $4,616.62 / $4,616.62	Facility		$1,551.96	$4,616.62	$4,616.62
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,395.53 / $4,459.63 / $9,004.79	Facility		$1,395.53	$4,459.63	$9,004.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,018.74 / $3,592.92 / $4,082.86	Professional		$1,018.74	$3,592.92	$4,082.86
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $574.47 / $1,632.42 / $2,480.90	Facility		$574.47	$1,632.42	$2,480.90
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,235.22 / $2,157.30 / $2,588.76	Professional		$1,235.22	$2,157.30	$2,588.76
Medica Facility/Professional Facility Modifier Low / Median / High Price $994.43 / $2,157.30 / $9,370.62	Facility		$994.43	$2,157.30	$9,370.62
Medica Facility/Professional Professional Modifier Low / Median / High Price $859.44 / $1,076.26 / $2,349.03	Professional		$859.44	$1,076.26	$2,349.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,311.13	Professional		$50.00	$70.00	$1,311.13
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $574.47 / $1,632.42 / $2,480.90	Facility		$574.47	$1,632.42	$2,480.90
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,235.22 / $2,157.30 / $2,588.76	Professional		$1,235.22	$2,157.30	$2,588.76
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,157.30 / $3,320.01 / $5,339.68	Professional		$2,157.30	$3,320.01	$5,339.68
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,395.53 / $4,213.47 / $9,370.62	Facility		$1,395.53	$4,213.47	$9,370.62
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,018.74 / $1,395.53 / $11,357.28	Professional		$1,018.74	$1,395.53	$11,357.28
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,157.30 / $2,157.30 / $2,157.30	Professional		$2,157.30	$2,157.30	$2,157.30
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,157.30 / $2,157.30 / $2,157.30	Professional		$2,157.30	$2,157.30	$2,157.30
United Facility/Professional Professional Modifier Low / Median / High Price $717.50 / $1,076.26 / $1,912.70	Professional		$717.50	$1,076.26	$1,912.70