Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,097.27 / $1,097.27 / $1,097.27	Facility		$1,097.27	$1,097.27	$1,097.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,038.55 / $1,097.27 / $1,972.39	Professional		$1,038.55	$1,097.27	$1,972.39
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,175.13 / $2,392.64 / $3,958.74	Facility		$2,175.13	$2,392.64	$3,958.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,957.61 / $2,022.87 / $2,675.40	Professional		$1,957.61	$2,022.87	$2,675.40
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,564.79 / $4,654.78 / $4,654.78	Facility		$1,564.79	$4,654.78	$4,654.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,540.39 / $4,802.80 / $9,078.96	Facility		$1,540.39	$4,802.80	$9,078.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,124.48 / $3,202.31 / $4,116.60	Professional		$1,124.48	$3,202.31	$4,116.60
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $625.83 / $1,645.91 / $2,501.40	Facility		$625.83	$1,645.91	$2,501.40
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,245.42 / $2,123.00 / $2,610.16	Professional		$1,245.42	$2,123.00	$2,610.16
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,083.33 / $2,175.13 / $10,128.96	Facility		$1,083.33	$2,175.13	$10,128.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $949.81 / $1,139.41 / $2,368.44	Professional		$949.81	$1,139.41	$2,368.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,214.00	Professional		$50.00	$70.00	$1,214.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $625.83 / $1,645.91 / $2,501.40	Facility		$625.83	$1,645.91	$2,501.40
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,245.42 / $2,123.00 / $2,610.16	Professional		$1,245.42	$2,123.00	$2,610.16
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,175.13 / $3,347.46 / $5,816.44	Professional		$2,175.13	$3,347.46	$5,816.44
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,540.39 / $4,248.30 / $10,128.96	Facility		$1,540.39	$4,248.30	$10,128.96
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,124.48 / $1,540.39 / $10,951.02	Professional		$1,124.48	$1,540.39	$10,951.02
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,175.13 / $2,175.13 / $2,175.13	Professional		$2,175.13	$2,175.13	$2,175.13
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,175.13 / $2,175.13 / $2,175.13	Professional		$2,175.13	$2,175.13	$2,175.13
United Facility/Professional Professional Modifier Low / Median / High Price $759.03 / $1,085.15 / $2,072.66	Professional		$759.03	$1,085.15	$2,072.66