Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,379.81 / $1,379.81 / $1,379.81	Facility		$1,379.81	$1,379.81	$1,379.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,010.30 / $1,379.81 / $2,291.01	Professional		$1,010.30	$1,379.81	$2,291.01
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,735.22 / $3,008.74 / $4,978.10	Facility		$2,735.22	$3,008.74	$4,978.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,365.67 / $2,543.75 / $3,364.32	Professional		$2,365.67	$2,543.75	$3,364.32
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,967.71 / $5,853.37 / $5,853.37	Facility		$1,967.71	$5,853.37	$5,853.37
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,769.38 / $5,654.76 / $11,417.64	Facility		$1,769.38	$5,654.76	$11,417.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,291.65 / $3,963.75 / $5,176.60	Professional		$1,291.65	$3,963.75	$5,176.60
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $781.11 / $2,069.71 / $3,145.50	Facility		$781.11	$2,069.71	$3,145.50
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,566.12 / $2,735.22 / $3,282.26	Professional		$1,566.12	$2,735.22	$3,282.26
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,352.14 / $2,735.22 / $12,904.54	Facility		$1,352.14	$2,735.22	$12,904.54
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,232.08 / $1,820.77 / $3,024.83	Professional		$1,232.08	$1,820.77	$3,024.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,636.69	Professional		$50.00	$70.00	$1,636.69
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $781.11 / $2,069.71 / $3,145.50	Facility		$781.11	$2,069.71	$3,145.50
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,566.12 / $2,735.22 / $3,282.26	Professional		$1,566.12	$2,735.22	$3,282.26
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,735.22 / $4,209.39 / $7,259.76	Professional		$2,735.22	$4,209.39	$7,259.76
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,769.38 / $5,342.22 / $12,904.54	Facility		$1,769.38	$5,342.22	$12,904.54
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,291.65 / $1,769.38 / $15,361.01	Professional		$1,291.65	$1,769.38	$15,361.01
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,735.22 / $2,735.22 / $2,735.22	Professional		$2,735.22	$2,735.22	$2,735.22
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,735.22 / $2,735.22 / $2,735.22	Professional		$2,735.22	$2,735.22	$2,735.22
United Facility/Professional Professional Modifier Low / Median / High Price $1,008.28 / $1,641.13 / $2,735.22	Professional		$1,008.28	$1,641.13	$2,735.22