Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,091.54 / $1,091.54 / $1,091.54	Facility		$1,091.54	$1,091.54	$1,091.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $906.27 / $1,091.54 / $1,828.78	Professional		$906.27	$1,091.54	$1,828.78
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,163.77 / $2,380.15 / $3,938.06	Facility		$2,163.77	$2,380.15	$3,938.06
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,871.44 / $2,012.31 / $2,661.43	Professional		$1,871.44	$2,012.31	$2,661.43
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,556.61 / $4,630.47 / $4,630.47	Facility		$1,556.61	$4,630.47	$4,630.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,207.83 / $4,473.72 / $9,031.39	Facility		$1,207.83	$4,473.72	$9,031.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $881.72 / $3,135.47 / $4,095.11	Professional		$881.72	$3,135.47	$4,095.11
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $622.55 / $1,637.31 / $2,488.34	Facility		$622.55	$1,637.31	$2,488.34
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,238.93 / $2,111.91 / $2,596.52	Professional		$1,238.93	$2,111.91	$2,596.52
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,077.66 / $2,163.77 / $10,094.70	Facility		$1,077.66	$2,163.77	$10,094.70
Medica Facility/Professional Professional Modifier Low / Median / High Price $977.29 / $1,445.78 / $2,356.08	Professional		$977.29	$1,445.78	$2,356.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,460.24	Professional		$50.00	$70.00	$1,460.24
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $622.55 / $1,637.31 / $2,488.34	Facility		$622.55	$1,637.31	$2,488.34
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,238.93 / $2,111.91 / $2,596.52	Professional		$1,238.93	$2,111.91	$2,596.52
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,163.77 / $3,329.94 / $5,786.33	Professional		$2,163.77	$3,329.94	$5,786.33
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,207.83 / $4,226.12 / $10,094.70	Facility		$1,207.83	$4,226.12	$10,094.70
Quartz Facility/Professional Professional Modifier Low / Median / High Price $881.72 / $1,207.83 / $11,655.70	Professional		$881.72	$1,207.83	$11,655.70
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,163.77 / $2,163.77 / $2,163.77	Professional		$2,163.77	$2,163.77	$2,163.77
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,727.72 / $2,163.77 / $2,163.77	Professional		$1,727.72	$2,163.77	$2,163.77
United Facility/Professional Facility Modifier Low / Median / High Price $1,055.55 / $1,055.55 / $1,055.55	Facility		$1,055.55	$1,055.55	$1,055.55
United Facility/Professional Professional Modifier Low / Median / High Price $862.02 / $1,298.26 / $2,163.77	Professional		$862.02	$1,298.26	$2,163.77