Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,467.85 / $1,467.85 / $1,467.85	Facility		$1,467.85	$1,467.85	$1,467.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,189.72 / $1,467.85 / $2,437.19	Professional		$1,189.72	$1,467.85	$2,437.19
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,909.74 / $3,200.71 / $5,295.73	Facility		$2,909.74	$3,200.71	$5,295.73
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,516.63 / $2,706.06 / $3,578.98	Professional		$2,516.63	$2,706.06	$3,578.98
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,093.26 / $6,226.84 / $6,226.84	Facility		$2,093.26	$6,226.84	$6,226.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,050.41 / $6,015.90 / $12,145.42	Facility		$2,050.41	$6,015.90	$12,145.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,496.80 / $4,846.07 / $5,506.90	Professional		$1,496.80	$4,846.07	$5,506.90
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $919.83 / $2,201.78 / $3,346.20	Facility		$919.83	$2,201.78	$3,346.20
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,666.04 / $2,909.74 / $3,807.96	Professional		$1,666.04	$2,909.74	$3,807.96
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,467.85 / $2,909.74 / $15,093.28	Facility		$1,467.85	$2,909.74	$15,093.28
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,352.89 / $1,944.20 / $3,285.04	Professional		$1,352.89	$1,944.20	$3,285.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,927.36	Professional		$50.00	$70.00	$1,927.36
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $919.83 / $2,245.81 / $3,346.20	Facility		$919.83	$2,245.81	$3,346.20
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,666.04 / $2,909.74 / $3,807.96	Professional		$1,666.04	$2,909.74	$3,807.96
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,909.74 / $4,477.99 / $8,549.52	Professional		$2,909.74	$4,477.99	$8,549.52
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,050.41 / $5,683.08 / $15,093.28	Facility		$2,050.41	$5,683.08	$15,093.28
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,496.80 / $2,050.41 / $18,918.90	Professional		$1,496.80	$2,050.41	$18,918.90
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,909.74 / $2,909.74 / $2,909.74	Professional		$2,909.74	$2,909.74	$2,909.74
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,909.74 / $2,909.74 / $2,909.74	Professional		$2,909.74	$2,909.74	$2,909.74
United Facility/Professional Professional Modifier Low / Median / High Price $1,159.20 / $1,899.75 / $2,579.82	Professional		$1,159.20	$1,899.75	$2,579.82