Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,483.84 / $1,483.84 / $1,483.84	Facility		$1,483.84	$1,483.84	$1,483.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,259.48 / $1,483.84 / $2,541.53	Professional		$1,259.48	$1,483.84	$2,541.53
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,941.43 / $3,235.57 / $5,353.40	Facility		$2,941.43	$3,235.57	$5,353.40
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,647.28 / $2,735.53 / $3,617.95	Professional		$2,647.28	$2,735.53	$3,617.95
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,116.06 / $6,294.66 / $6,294.66	Facility		$2,116.06	$6,294.66	$6,294.66
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,902.78 / $6,081.58 / $12,278.38	Facility		$1,902.78	$6,081.58	$12,278.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,389.03 / $4,262.34 / $5,566.89	Professional		$1,389.03	$4,262.34	$5,566.89
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $947.36 / $2,225.76 / $3,382.64	Facility		$947.36	$2,225.76	$3,382.64
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,684.19 / $2,941.43 / $3,921.91	Professional		$1,684.19	$2,941.43	$3,921.91
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,483.84 / $2,941.43 / $15,444.00	Facility		$1,483.84	$2,941.43	$15,444.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,367.63 / $1,965.38 / $3,320.82	Professional		$1,367.63	$1,965.38	$3,320.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,985.03	Professional		$50.00	$70.00	$1,985.03
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $947.36 / $2,270.28 / $3,382.64	Facility		$947.36	$2,270.28	$3,382.64
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,684.19 / $2,941.43 / $3,921.91	Professional		$1,684.19	$2,941.43	$3,921.91
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,941.43 / $4,526.76 / $8,805.45	Professional		$2,941.43	$4,526.76	$8,805.45
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,902.78 / $5,744.98 / $15,444.00	Facility		$1,902.78	$5,744.98	$15,444.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,389.03 / $1,902.78 / $18,825.16	Professional		$1,389.03	$1,902.78	$18,825.16
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,941.43 / $2,941.43 / $2,941.43	Professional		$2,941.43	$2,941.43	$2,941.43
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,941.43 / $2,941.43 / $2,941.43	Professional		$2,941.43	$2,941.43	$2,941.43
United Facility/Professional Professional Modifier Low / Median / High Price $1,171.83 / $1,956.60 / $2,607.92	Professional		$1,171.83	$1,956.60	$2,607.92