Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,867.99 / $1,867.99 / $1,867.99	Facility		$1,867.99	$1,867.99	$1,867.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,432.56 / $1,867.99 / $3,101.56	Professional		$1,432.56	$1,867.99	$3,101.56
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,702.93 / $4,073.22 / $6,739.33	Facility		$3,702.93	$4,073.22	$6,739.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,202.65 / $3,443.72 / $4,554.60	Professional		$3,202.65	$3,443.72	$4,554.60
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,663.87 / $7,924.27 / $7,924.27	Facility		$2,663.87	$7,924.27	$7,924.27
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,400.00 / $7,655.67 / $15,456.78	Facility		$2,400.00	$7,655.67	$15,456.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,752.00 / $5,366.25 / $7,008.08	Professional		$1,752.00	$5,366.25	$7,008.08
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,058.63 / $2,801.99 / $4,258.37	Facility		$1,058.63	$2,801.99	$4,258.37
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $2,120.21 / $3,702.93 / $4,443.52	Professional		$2,120.21	$3,702.93	$4,443.52
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,832.53 / $3,702.93 / $17,077.79	Facility		$1,832.53	$3,702.93	$17,077.79
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,668.00 / $2,467.67 / $4,099.52	Professional		$1,668.00	$2,467.67	$4,099.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $2,498.94	Professional		$50.00	$70.00	$2,498.94
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,058.63 / $2,801.99 / $4,258.37	Facility		$1,058.63	$2,801.99	$4,258.37
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $2,120.21 / $3,702.93 / $4,443.52	Professional		$2,120.21	$3,702.93	$4,443.52
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,702.93 / $5,698.67 / $9,839.27	Professional		$3,702.93	$5,698.67	$9,839.27
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,400.00 / $7,232.28 / $17,077.79	Facility		$2,400.00	$7,232.28	$17,077.79
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,752.00 / $2,400.00 / $21,693.67	Professional		$1,752.00	$2,400.00	$21,693.67
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,702.93 / $3,702.93 / $3,702.93	Professional		$3,702.93	$3,702.93	$3,702.93
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,956.71 / $3,702.93 / $3,702.93	Professional		$2,956.71	$3,702.93	$3,702.93
United Facility/Professional Professional Modifier Low / Median / High Price $1,366.51 / $2,166.90 / $3,175.83	Professional		$1,366.51	$2,166.90	$3,175.83