Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,072.43 / $1,072.43 / $1,072.43	Facility		$1,072.43	$1,072.43	$1,072.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $727.92 / $1,072.43 / $1,780.64	Professional		$727.92	$1,072.43	$1,780.64
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,125.90 / $2,338.48 / $3,869.14	Facility		$2,125.90	$2,338.48	$3,869.14
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,977.09 / $1,977.09 / $2,614.85	Professional		$1,977.09	$1,977.09	$2,614.85
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,529.36 / $4,549.43 / $4,549.43	Facility		$1,529.36	$4,549.43	$4,549.43
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,375.24 / $4,394.92 / $8,873.24	Facility		$1,375.24	$4,394.92	$8,873.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,003.93 / $3,080.63 / $4,023.43	Professional		$1,003.93	$3,080.63	$4,023.43
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $562.79 / $1,608.65 / $2,444.79	Facility		$562.79	$1,608.65	$2,444.79
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,217.25 / $2,111.46 / $2,551.08	Professional		$1,217.25	$2,111.46	$2,551.08
Medica Facility/Professional Facility Modifier Low / Median / High Price $974.22 / $2,125.90 / $9,328.83	Facility		$974.22	$2,125.90	$9,328.83
Medica Facility/Professional Professional Modifier Low / Median / High Price $957.62 / $1,313.18 / $2,314.84	Professional		$957.62	$1,313.18	$2,314.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,179.24	Professional		$50.00	$70.00	$1,179.24
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $562.79 / $1,608.65 / $2,444.79	Facility		$562.79	$1,608.65	$2,444.79
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,217.25 / $2,111.46 / $2,551.08	Professional		$1,217.25	$2,111.46	$2,551.08
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,125.90 / $3,271.68 / $5,230.28	Professional		$2,125.90	$3,271.68	$5,230.28
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,375.24 / $4,152.14 / $9,328.83	Facility		$1,375.24	$4,152.14	$9,328.83
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,003.93 / $1,375.24 / $10,136.07	Professional		$1,003.93	$1,375.24	$10,136.07
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,125.90 / $2,125.90 / $2,125.90	Professional		$2,125.90	$2,125.90	$2,125.90
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,125.90 / $2,125.90 / $2,125.90	Professional		$2,125.90	$2,125.90	$2,125.90
United Facility/Professional Professional Modifier Low / Median / High Price $726.47 / $1,151.98 / $1,823.28	Professional		$726.47	$1,151.98	$1,823.28