Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,518.39 / $1,518.39 / $1,518.39	Facility		$1,518.39	$1,518.39	$1,518.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,140.84 / $1,518.39 / $2,521.09	Professional		$1,140.84	$1,518.39	$2,521.09
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,009.91 / $3,310.90 / $5,478.04	Facility		$3,009.91	$3,310.90	$5,478.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,799.22 / $2,799.22 / $3,702.18	Professional		$2,799.22	$2,799.22	$3,702.18
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,165.32 / $6,441.21 / $6,441.21	Facility		$2,165.32	$6,441.21	$6,441.21
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,711.28 / $6,222.29 / $12,563.89	Facility		$1,711.28	$6,222.29	$12,563.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,249.23 / $4,361.72 / $5,696.50	Professional		$1,249.23	$4,361.72	$5,696.50
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $882.05 / $2,277.59 / $3,461.40	Facility		$882.05	$2,277.59	$3,461.40
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,723.40 / $3,009.91 / $3,617.83	Professional		$1,723.40	$3,009.91	$3,617.83
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,518.39 / $3,009.91 / $14,301.99	Facility		$1,518.39	$3,009.91	$14,301.99
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,384.64 / $2,011.13 / $3,398.13	Professional		$1,384.64	$2,011.13	$3,398.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,755.90	Professional		$50.00	$70.00	$1,755.90
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $882.05 / $2,277.59 / $3,461.40	Facility		$882.05	$2,277.59	$3,461.40
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,723.40 / $3,009.91 / $3,617.83	Professional		$1,723.40	$3,009.91	$3,617.83
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,009.91 / $4,632.14 / $8,198.21	Professional		$3,009.91	$4,632.14	$8,198.21
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,711.28 / $5,878.74 / $14,301.99	Facility		$1,711.28	$5,878.74	$14,301.99
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,249.23 / $1,711.28 / $17,908.25	Professional		$1,249.23	$1,711.28	$17,908.25
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,009.91 / $3,009.91 / $3,009.91	Professional		$3,009.91	$3,009.91	$3,009.91
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,403.33 / $3,009.91 / $3,009.91	Professional		$2,403.33	$3,009.91	$3,009.91
United Facility/Professional Professional Modifier Low / Median / High Price $1,199.10 / $2,002.14 / $3,009.91	Professional		$1,199.10	$2,002.14	$3,009.91