Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,263.71 / $1,263.71 / $1,263.71	Facility		$1,263.71	$1,263.71	$1,263.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $863.60 / $1,263.71 / $2,098.23	Professional		$863.60	$1,263.71	$2,098.23
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,505.05 / $2,755.56 / $4,559.18	Facility		$2,505.05	$2,755.56	$4,559.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,280.41 / $2,329.69 / $3,081.21	Professional		$2,280.41	$2,329.69	$3,081.21
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,802.13 / $5,360.81 / $5,360.81	Facility		$1,802.13	$5,360.81	$5,360.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,295.39 / $5,179.14 / $10,456.14	Facility		$1,295.39	$5,179.14	$10,456.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $945.63 / $3,630.00 / $4,741.01	Professional		$945.63	$3,630.00	$4,741.01
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $667.69 / $1,895.57 / $2,880.81	Facility		$667.69	$1,895.57	$2,880.81
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,434.32 / $2,505.05 / $3,006.06	Professional		$1,434.32	$2,505.05	$3,006.06
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,155.80 / $2,505.05 / $10,873.70	Facility		$1,155.80	$2,505.05	$10,873.70
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,101.54 / $1,557.95 / $2,727.70	Professional		$1,101.54	$1,557.95	$2,727.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,399.04	Professional		$50.00	$70.00	$1,399.04
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $667.69 / $1,895.57 / $2,880.81	Facility		$667.69	$1,895.57	$2,880.81
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,434.32 / $2,505.05 / $3,006.06	Professional		$1,434.32	$2,505.05	$3,006.06
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,505.05 / $3,855.20 / $6,205.88	Professional		$2,505.05	$3,855.20	$6,205.88
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,295.39 / $4,892.68 / $10,873.70	Facility		$1,295.39	$4,892.68	$10,873.70
Quartz Facility/Professional Professional Modifier Low / Median / High Price $945.63 / $1,295.39 / $13,267.87	Professional		$945.63	$1,295.39	$13,267.87
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,505.05 / $2,505.05 / $2,505.05	Professional		$2,505.05	$2,505.05	$2,505.05
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,505.05 / $2,505.05 / $2,505.05	Professional		$2,505.05	$2,505.05	$2,505.05
United Facility/Professional Professional Modifier Low / Median / High Price $861.88 / $1,503.03 / $2,505.05	Professional		$861.88	$1,503.03	$2,505.05