Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,174.36 / $1,174.36 / $1,174.36	Facility		$1,174.36	$1,174.36	$1,174.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $917.07 / $1,174.36 / $1,741.67	Professional		$917.07	$1,174.36	$1,741.67
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,327.96 / $2,560.77 / $4,236.91	Facility		$2,327.96	$2,560.77	$4,236.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,165.01 / $2,165.01 / $2,863.40	Professional		$2,165.01	$2,165.01	$2,863.40
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,674.73 / $4,981.85 / $4,981.85	Facility		$1,674.73	$4,981.85	$4,981.85
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,107.01 / $4,813.29 / $9,717.17	Facility		$1,107.01	$4,813.29	$9,717.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,107.01 / $2,725.86 / $4,405.85	Professional		$1,107.01	$2,725.86	$4,405.85
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $570.59 / $1,761.56 / $2,677.17	Facility		$570.59	$1,761.56	$2,677.17
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,332.94 / $2,149.73 / $2,793.56	Professional		$1,332.94	$2,149.73	$2,793.56
Medica Facility/Professional Facility Modifier Low / Median / High Price $987.72 / $2,327.96 / $9,312.17	Facility		$987.72	$2,327.96	$9,312.17
Medica Facility/Professional Professional Modifier Low / Median / High Price $883.84 / $1,161.40 / $2,534.88	Professional		$883.84	$1,161.40	$2,534.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,223.17	Professional		$50.00	$70.00	$1,223.17
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $570.59 / $1,761.56 / $2,677.17	Facility		$570.59	$1,761.56	$2,677.17
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,332.94 / $2,149.73 / $2,793.56	Professional		$1,332.94	$2,149.73	$2,793.56
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,327.96 / $3,491.96 / $5,303.55	Professional		$2,327.96	$3,491.96	$5,303.55
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,107.01 / $4,546.82 / $9,312.17	Facility		$1,107.01	$4,546.82	$9,312.17
Quartz Facility/Professional Professional Modifier Low / Median / High Price $808.12 / $1,107.01 / $11,304.00	Professional		$808.12	$1,107.01	$11,304.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,327.96 / $2,327.96 / $2,327.96	Professional		$2,327.96	$2,327.96	$2,327.96
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,327.96 / $2,327.96 / $2,327.96	Professional		$2,327.96	$2,327.96	$2,327.96
United Facility/Professional Professional Modifier Low / Median / High Price $736.54 / $1,161.40 / $2,064.02	Professional		$736.54	$1,161.40	$2,064.02