Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,757.68 / $1,757.68 / $1,757.68	Facility		$1,757.68	$1,757.68	$1,757.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,213.26 / $1,757.68 / $2,918.41	Professional		$1,213.26	$1,757.68	$2,918.41
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,484.26 / $3,832.69 / $6,341.35	Facility		$3,484.26	$3,832.69	$6,341.35
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,013.53 / $3,240.36 / $4,285.63	Professional		$3,013.53	$3,240.36	$4,285.63
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,506.57 / $7,456.32 / $7,456.32	Facility		$2,506.57	$7,456.32	$7,456.32
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,819.89 / $7,203.54 / $14,544.27	Facility		$1,819.89	$7,203.54	$14,544.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,328.52 / $5,049.38 / $6,594.24	Professional		$1,328.52	$5,049.38	$6,594.24
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $938.03 / $2,636.52 / $4,006.90	Facility		$938.03	$2,636.52	$4,006.90
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,995.00 / $3,484.26 / $4,181.10	Professional		$1,995.00	$3,484.26	$4,181.10
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,623.78 / $3,484.26 / $15,534.23	Facility		$1,623.78	$3,484.26	$15,534.23
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,559.71 / $2,188.75 / $3,793.93	Professional		$1,559.71	$2,188.75	$3,793.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,613.32	Professional		$50.00	$70.00	$1,613.32
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $938.03 / $2,636.52 / $4,006.90	Facility		$938.03	$2,636.52	$4,006.90
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,995.00 / $3,484.26 / $4,181.10	Professional		$1,995.00	$3,484.26	$4,181.10
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,484.26 / $5,362.17 / $8,718.14	Professional		$3,484.26	$5,362.17	$8,718.14
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,819.89 / $6,805.20 / $15,534.23	Facility		$1,819.89	$6,805.20	$15,534.23
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,328.52 / $1,819.89 / $19,222.38	Professional		$1,328.52	$1,819.89	$19,222.38
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,484.26 / $3,484.26 / $3,484.26	Professional		$3,484.26	$3,484.26	$3,484.26
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,484.26 / $3,484.26 / $3,484.26	Professional		$3,484.26	$3,484.26	$3,484.26
United Facility/Professional Facility Modifier Low / Median / High Price $1,776.27 / $1,776.27 / $1,776.27	Facility		$1,776.27	$1,776.27	$1,776.27
United Facility/Professional Professional Modifier Low / Median / High Price $1,158.83 / $1,937.34 / $3,089.20	Professional		$1,158.83	$1,937.34	$3,089.20