Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,536.40 / $1,536.40 / $1,536.40	Facility		$1,536.40	$1,536.40	$1,536.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,126.39 / $1,536.40 / $2,551.00	Professional		$1,126.39	$1,536.40	$2,551.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,045.61 / $3,350.17 / $5,543.01	Facility		$3,045.61	$3,350.17	$5,543.01
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,634.15 / $2,832.42 / $3,746.10	Professional		$2,634.15	$2,832.42	$3,746.10
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,191.01 / $6,517.61 / $6,517.61	Facility		$2,191.01	$6,517.61	$6,517.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,119.51 / $6,724.31 / $12,712.24	Facility		$2,119.51	$6,724.31	$12,712.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,547.24 / $4,483.89 / $5,764.06	Professional		$1,547.24	$4,483.89	$5,764.06
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $808.65 / $2,304.60 / $3,502.45	Facility		$808.65	$2,304.60	$3,502.45
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,743.84 / $2,889.21 / $3,654.73	Professional		$1,743.84	$2,889.21	$3,654.73
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,399.80 / $3,045.61 / $13,256.99	Facility		$1,399.80	$3,045.61	$13,256.99
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,283.36 / $1,886.84 / $3,316.30	Professional		$1,283.36	$1,886.84	$3,316.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $2,014.95	Professional		$50.00	$70.00	$2,014.95
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $808.65 / $2,304.60 / $3,502.45	Facility		$808.65	$2,304.60	$3,502.45
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,743.84 / $2,889.21 / $3,654.73	Professional		$1,743.84	$2,889.21	$3,654.73
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,045.61 / $4,687.08 / $7,515.71	Professional		$3,045.61	$4,687.08	$7,515.71
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,119.51 / $5,948.46 / $13,256.99	Facility		$2,119.51	$5,948.46	$13,256.99
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,547.24 / $2,119.51 / $15,834.51	Professional		$1,547.24	$2,119.51	$15,834.51
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,045.61 / $3,045.61 / $3,045.61	Professional		$3,045.61	$3,045.61	$3,045.61
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,045.61 / $3,045.61 / $3,045.61	Professional		$3,045.61	$3,045.61	$3,045.61
United Facility/Professional Professional Modifier Low / Median / High Price $1,043.82 / $1,670.11 / $3,045.61	Professional		$1,043.82	$1,670.11	$3,045.61