Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,216.58 / $1,216.58 / $1,216.58	Facility		$1,216.58	$1,216.58	$1,216.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,010.07 / $1,216.58 / $2,038.23	Professional		$1,010.07	$1,216.58	$2,038.23
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,411.64 / $2,652.80 / $4,389.18	Facility		$2,411.64	$2,652.80	$4,389.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,085.83 / $2,242.83 / $2,966.31	Professional		$2,085.83	$2,242.83	$2,966.31
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,734.93 / $5,160.91 / $5,160.91	Facility		$1,734.93	$5,160.91	$5,160.91
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,346.19 / $4,985.89 / $10,067.06	Facility		$1,346.19	$4,985.89	$10,067.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $982.72 / $3,495.00 / $4,564.22	Professional		$982.72	$3,495.00	$4,564.22
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $693.87 / $1,824.87 / $2,773.39	Facility		$693.87	$1,824.87	$2,773.39
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,380.85 / $2,353.86 / $2,893.97	Professional		$1,380.85	$2,353.86	$2,893.97
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,201.11 / $2,411.64 / $11,271.87	Facility		$1,201.11	$2,411.64	$11,271.87
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,089.24 / $1,611.39 / $2,625.98	Professional		$1,089.24	$1,611.39	$2,625.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,570.37	Professional		$50.00	$70.00	$1,570.37
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $693.87 / $1,824.87 / $2,773.39	Facility		$693.87	$1,824.87	$2,773.39
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,380.85 / $2,353.86 / $2,893.97	Professional		$1,380.85	$2,353.86	$2,893.97
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,411.64 / $3,711.45 / $6,448.77	Professional		$2,411.64	$3,711.45	$6,448.77
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,346.19 / $4,710.24 / $11,271.87	Facility		$1,346.19	$4,710.24	$11,271.87
Quartz Facility/Professional Professional Modifier Low / Median / High Price $982.72 / $1,346.19 / $12,141.34	Professional		$982.72	$1,346.19	$12,141.34
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,411.64 / $2,411.64 / $2,411.64	Professional		$2,411.64	$2,411.64	$2,411.64
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,925.63 / $2,411.64 / $2,411.64	Professional		$1,925.63	$2,411.64	$2,411.64
United Facility/Professional Professional Modifier Low / Median / High Price $841.56 / $1,433.07 / $2,411.64	Professional		$841.56	$1,433.07	$2,411.64