Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,247.71 / $1,247.71 / $1,247.71	Facility		$1,247.71	$1,247.71	$1,247.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $904.96 / $1,247.71 / $2,071.67	Professional		$904.96	$1,247.71	$2,071.67
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,473.35 / $2,720.69 / $4,501.50	Facility		$2,473.35	$2,720.69	$4,501.50
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,139.19 / $2,300.21 / $3,042.22	Professional		$2,139.19	$2,300.21	$3,042.22
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,779.33 / $5,292.97 / $5,292.97	Facility		$1,779.33	$5,292.97	$5,292.97
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,599.98 / $5,113.47 / $10,324.58	Facility		$1,599.98	$5,113.47	$10,324.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,167.99 / $3,584.06 / $4,681.01	Professional		$1,167.99	$3,584.06	$4,681.01
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $699.67 / $1,871.57 / $2,844.35	Facility		$699.67	$1,871.57	$2,844.35
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,416.18 / $2,473.35 / $2,968.02	Professional		$1,416.18	$2,473.35	$2,968.02
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,211.16 / $2,473.35 / $11,580.89	Facility		$1,211.16	$2,473.35	$11,580.89
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,114.13 / $1,632.56 / $2,709.45	Professional		$1,114.13	$1,632.56	$2,709.45
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,466.05	Professional		$50.00	$70.00	$1,466.05
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $699.67 / $1,871.57 / $2,844.35	Facility		$699.67	$1,871.57	$2,844.35
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,416.18 / $2,473.35 / $2,968.02	Professional		$1,416.18	$2,473.35	$2,968.02
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,473.35 / $3,806.42 / $6,502.97	Professional		$2,473.35	$3,806.42	$6,502.97
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,599.98 / $4,830.76 / $11,580.89	Facility		$1,599.98	$4,830.76	$11,580.89
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,167.99 / $1,599.98 / $13,894.08	Professional		$1,167.99	$1,599.98	$13,894.08
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,473.35 / $2,473.35 / $2,473.35	Professional		$2,473.35	$2,473.35	$2,473.35
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,473.35 / $2,473.35 / $2,473.35	Professional		$2,473.35	$2,473.35	$2,473.35
United Facility/Professional Professional Modifier Low / Median / High Price $903.15 / $1,484.01 / $2,192.91	Professional		$903.15	$1,484.01	$2,192.91