Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,052.08 / $1,052.08 / $1,052.08	Facility		$1,052.08	$1,052.08	$1,052.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $754.69 / $1,052.08 / $1,746.86	Professional		$754.69	$1,052.08	$1,746.86
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,085.56 / $2,294.12 / $3,795.72	Facility		$2,085.56	$2,294.12	$3,795.72
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,939.57 / $1,939.57 / $2,565.23	Professional		$1,939.57	$1,939.57	$2,565.23
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,500.34 / $4,463.10 / $4,463.10	Facility		$1,500.34	$4,463.10	$4,463.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,349.13 / $4,311.43 / $8,705.29	Facility		$1,349.13	$4,311.43	$8,705.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $984.86 / $3,473.44 / $3,947.09	Professional		$984.86	$3,473.44	$3,947.09
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $583.49 / $1,578.14 / $2,398.39	Facility		$583.49	$1,578.14	$2,398.39
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,194.14 / $2,085.56 / $2,502.67	Professional		$1,194.14	$2,085.56	$2,502.67
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,010.04 / $2,085.56 / $9,687.79	Facility		$1,010.04	$2,085.56	$9,687.79
Medica Facility/Professional Professional Modifier Low / Median / High Price $939.44 / $1,361.47 / $2,270.92	Professional		$939.44	$1,361.47	$2,270.92
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,222.60	Professional		$50.00	$70.00	$1,222.60
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $583.49 / $1,578.14 / $2,398.39	Facility		$583.49	$1,578.14	$2,398.39
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,194.14 / $2,085.56 / $2,502.67	Professional		$1,194.14	$2,085.56	$2,502.67
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,085.56 / $3,209.59 / $5,422.99	Professional		$2,085.56	$3,209.59	$5,422.99
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,349.13 / $4,073.36 / $9,687.79	Facility		$1,349.13	$4,073.36	$9,687.79
Quartz Facility/Professional Professional Modifier Low / Median / High Price $984.86 / $1,349.13 / $11,956.97	Professional		$984.86	$1,349.13	$11,956.97
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,085.56 / $2,085.56 / $2,085.56	Professional		$2,085.56	$2,085.56	$2,085.56
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,085.56 / $2,085.56 / $2,085.56	Professional		$2,085.56	$2,085.56	$2,085.56
United Facility/Professional Professional Modifier Low / Median / High Price $816.88 / $1,329.37 / $1,849.09	Professional		$816.88	$1,329.37	$1,849.09