Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,785.50 / $1,785.50 / $1,785.50	Facility		$1,785.50	$1,785.50	$1,785.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,201.94 / $1,785.50 / $2,964.61	Professional		$1,201.94	$1,785.50	$2,964.61
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,539.42 / $3,893.36 / $6,441.74	Facility		$3,539.42	$3,893.36	$6,441.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,185.47 / $3,291.66 / $4,353.47	Professional		$3,185.47	$3,291.66	$4,353.47
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,546.25 / $7,574.36 / $7,574.36	Facility		$2,546.25	$7,574.36	$7,574.36
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,289.62 / $7,317.04 / $14,773.80	Facility		$2,289.62	$7,317.04	$14,773.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,671.42 / $5,894.79 / $6,698.63	Professional		$1,671.42	$5,894.79	$6,698.63
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $929.28 / $2,678.25 / $4,070.33	Facility		$929.28	$2,678.25	$4,070.33
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $2,026.59 / $3,539.42 / $4,247.30	Professional		$2,026.59	$3,539.42	$4,247.30
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,608.62 / $3,539.42 / $15,617.77	Facility		$1,608.62	$3,539.42	$15,617.77
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,594.34 / $2,168.32 / $3,853.99	Professional		$1,594.34	$2,168.32	$3,853.99
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,947.16	Professional		$50.00	$70.00	$1,947.16
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $929.28 / $2,678.25 / $4,070.33	Facility		$929.28	$2,678.25	$4,070.33
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $2,026.59 / $3,539.42 / $4,247.30	Professional		$2,026.59	$3,539.42	$4,247.30
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,539.42 / $5,447.03 / $8,636.84	Professional		$3,539.42	$5,447.03	$8,636.84
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,289.62 / $6,912.92 / $15,617.77	Facility		$2,289.62	$6,912.92	$15,617.77
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,671.42 / $2,289.62 / $18,465.93	Professional		$1,671.42	$2,289.62	$18,465.93
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,539.42 / $3,539.42 / $3,539.42	Professional		$3,539.42	$3,539.42	$3,539.42
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,539.42 / $3,539.42 / $3,539.42	Professional		$3,539.42	$3,539.42	$3,539.42
United Facility/Professional Professional Modifier Low / Median / High Price $1,199.54 / $1,919.26 / $3,539.42	Professional		$1,199.54	$1,919.26	$3,539.42