Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,210.00 / $1,210.00 / $1,210.00	Facility		$1,210.00	$1,210.00	$1,210.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $948.75 / $1,210.00 / $2,009.06	Professional		$948.75	$1,210.00	$2,009.06
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,398.60 / $2,638.46 / $4,365.45	Facility		$2,398.60	$2,638.46	$4,365.45
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,074.55 / $2,230.69 / $2,950.27	Professional		$2,074.55	$2,230.69	$2,950.27
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,725.54 / $5,133.00 / $5,133.00	Facility		$1,725.54	$5,133.00	$5,133.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,654.54 / $4,958.71 / $10,012.48	Facility		$1,654.54	$4,958.71	$10,012.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,207.81 / $3,475.78 / $4,539.54	Professional		$1,207.81	$3,475.78	$4,539.54
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $733.52 / $1,815.00 / $2,758.39	Facility		$733.52	$1,815.00	$2,758.39
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,373.37 / $2,398.60 / $3,036.67	Professional		$1,373.37	$2,398.60	$3,036.67
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,210.00 / $2,398.60 / $12,123.54	Facility		$1,210.00	$2,398.60	$12,123.54
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,115.23 / $1,602.67 / $2,707.96	Professional		$1,115.23	$1,602.67	$2,707.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,172.96	Professional		$50.00	$70.00	$1,172.96
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $733.52 / $1,851.30 / $2,758.39	Facility		$733.52	$1,851.30	$2,758.39
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,373.37 / $2,398.60 / $3,036.67	Professional		$1,373.37	$2,398.60	$3,036.67
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,398.60 / $3,691.33 / $6,817.13	Professional		$2,398.60	$3,691.33	$6,817.13
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,654.54 / $4,684.76 / $12,123.54	Facility		$1,654.54	$4,684.76	$12,123.54
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,207.81 / $1,654.54 / $16,944.43	Professional		$1,207.81	$1,654.54	$16,944.43
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,398.60 / $2,398.60 / $2,398.60	Professional		$2,398.60	$2,398.60	$2,398.60
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,398.60 / $2,398.60 / $2,398.60	Professional		$2,398.60	$2,398.60	$2,398.60
United Facility/Professional Professional Modifier Low / Median / High Price $955.57 / $1,595.50 / $2,398.60	Professional		$955.57	$1,595.50	$2,398.60