Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,263.32 / $1,263.32 / $1,263.32	Facility		$1,263.32	$1,263.32	$1,263.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $888.12 / $1,263.32 / $2,097.59	Professional		$888.12	$1,263.32	$2,097.59
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,504.29 / $2,754.72 / $4,557.81	Facility		$2,504.29	$2,754.72	$4,557.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,165.96 / $2,328.98 / $3,080.27	Professional		$2,165.96	$2,328.98	$3,080.27
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,801.59 / $5,359.18 / $5,359.18	Facility		$1,801.59	$5,359.18	$5,359.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,620.00 / $5,177.28 / $10,453.34	Facility		$1,620.00	$5,177.28	$10,453.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,182.59 / $3,629.06 / $4,739.58	Professional		$1,182.59	$3,629.06	$4,739.58
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $672.36 / $1,894.98 / $2,879.93	Facility		$672.36	$1,894.98	$2,879.93
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,433.90 / $2,504.29 / $3,005.15	Professional		$1,433.90	$2,504.29	$3,005.15
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,163.89 / $2,504.29 / $11,250.63	Facility		$1,163.89	$2,504.29	$11,250.63
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,128.07 / $1,568.85 / $2,726.87	Professional		$1,128.07	$1,568.85	$2,726.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,407.82	Professional		$50.00	$70.00	$1,407.82
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $672.36 / $1,894.98 / $2,879.93	Facility		$672.36	$1,894.98	$2,879.93
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,433.90 / $2,504.29 / $3,005.15	Professional		$1,433.90	$2,504.29	$3,005.15
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,504.29 / $3,854.04 / $6,249.04	Professional		$2,504.29	$3,854.04	$6,249.04
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,620.00 / $4,891.20 / $11,250.63	Facility		$1,620.00	$4,891.20	$11,250.63
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,182.59 / $1,620.00 / $13,778.13	Professional		$1,182.59	$1,620.00	$13,778.13
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,504.29 / $2,504.29 / $2,504.29	Professional		$2,504.29	$2,504.29	$2,504.29
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,504.29 / $2,504.29 / $2,504.29	Professional		$2,504.29	$2,504.29	$2,504.29
United Facility/Professional Facility Modifier Low / Median / High Price $3,340.15 / $3,340.15 / $3,340.15	Facility		$3,340.15	$3,340.15	$3,340.15
United Facility/Professional Professional Modifier Low / Median / High Price $832.91 / $1,388.64 / $2,147.83	Professional		$832.91	$1,388.64	$2,147.83