Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,527.83 / $1,527.83 / $1,527.83	Facility		$1,527.83	$1,527.83	$1,527.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,085.30 / $1,527.83 / $2,536.78	Professional		$1,085.30	$1,527.83	$2,536.78
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,028.63 / $3,331.49 / $5,512.11	Facility		$3,028.63	$3,331.49	$5,512.11
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,725.76 / $2,816.63 / $3,725.21	Professional		$2,725.76	$2,816.63	$3,725.21
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,178.79 / $6,481.27 / $6,481.27	Facility		$2,178.79	$6,481.27	$6,481.27
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,486.28 / $6,261.70 / $12,642.26	Facility		$1,486.28	$6,261.70	$12,642.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,084.98 / $4,388.91 / $5,731.93	Professional		$1,084.98	$4,388.91	$5,731.93
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $766.08 / $2,291.75 / $3,482.92	Facility		$766.08	$2,291.75	$3,482.92
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,734.13 / $3,028.63 / $3,634.36	Professional		$1,734.13	$3,028.63	$3,634.36
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,326.11 / $3,028.63 / $12,494.15	Facility		$1,326.11	$3,028.63	$12,494.15
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,206.57 / $1,787.92 / $3,297.81	Professional		$1,206.57	$1,787.92	$3,297.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,605.19	Professional		$50.00	$70.00	$1,605.19
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $766.08 / $2,291.75 / $3,482.92	Facility		$766.08	$2,291.75	$3,482.92
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,734.13 / $3,028.63 / $3,634.36	Professional		$1,734.13	$3,028.63	$3,634.36
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,028.63 / $4,542.95 / $7,120.25	Professional		$3,028.63	$4,542.95	$7,120.25
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,486.28 / $5,915.30 / $12,494.15	Facility		$1,486.28	$5,915.30	$12,494.15
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,084.98 / $1,486.28 / $15,222.86	Professional		$1,084.98	$1,486.28	$15,222.86
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,028.63 / $3,028.63 / $3,028.63	Professional		$3,028.63	$3,028.63	$3,028.63
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,028.63 / $3,028.63 / $3,028.63	Professional		$3,028.63	$3,028.63	$3,028.63
United Facility/Professional Facility Modifier Low / Median / High Price $1,428.89 / $1,428.89 / $1,428.89	Facility		$1,428.89	$1,428.89	$1,428.89
United Facility/Professional Professional Modifier Low / Median / High Price $1,007.30 / $1,785.73 / $3,028.63	Professional		$1,007.30	$1,785.73	$3,028.63