Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,492.68 / $1,492.68 / $1,492.68	Facility		$1,492.68	$1,492.68	$1,492.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,192.81 / $1,492.68 / $2,478.41	Professional		$1,192.81	$1,492.68	$2,478.41
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,958.96 / $3,254.86 / $5,385.31	Facility		$2,958.96	$3,254.86	$5,385.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,663.06 / $2,751.83 / $3,639.52	Professional		$2,663.06	$2,751.83	$3,639.52
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,128.67 / $6,332.17 / $6,332.17	Facility		$2,128.67	$6,332.17	$6,332.17
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,800.00 / $6,117.22 / $12,351.15	Facility		$1,800.00	$6,117.22	$12,351.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,314.00 / $4,288.13 / $5,600.06	Professional		$1,314.00	$4,288.13	$5,600.06
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $736.00 / $2,239.02 / $3,402.80	Facility		$736.00	$2,239.02	$3,402.80
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,694.22 / $2,300.05 / $3,550.75	Professional		$1,694.22	$2,300.05	$3,550.75
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,274.04 / $2,958.96 / $11,959.60	Facility		$1,274.04	$2,958.96	$11,959.60
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,178.81 / $1,717.71 / $3,221.94	Professional		$1,178.81	$1,717.71	$3,221.94
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,597.60	Professional		$50.00	$70.00	$1,597.60
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $736.00 / $2,239.02 / $3,402.80	Facility		$736.00	$2,239.02	$3,402.80
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,694.22 / $2,300.05 / $3,550.75	Professional		$1,694.22	$2,300.05	$3,550.75
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,958.96 / $4,438.43 / $6,840.22	Professional		$2,958.96	$4,438.43	$6,840.22
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,800.00 / $5,779.22 / $11,959.60	Facility		$1,800.00	$5,779.22	$11,959.60
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,314.00 / $1,800.00 / $14,435.44	Professional		$1,314.00	$1,800.00	$14,435.44
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,958.96 / $2,958.96 / $2,958.96	Professional		$2,958.96	$2,958.96	$2,958.96
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,958.96 / $2,958.96 / $2,958.96	Professional		$2,958.96	$2,958.96	$2,958.96
United Facility/Professional Professional Modifier Low / Median / High Price $1,030.40 / $1,520.07 / $2,537.77	Professional		$1,030.40	$1,520.07	$2,537.77