Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,104.81 / $1,104.81 / $1,104.81	Facility		$1,104.81	$1,104.81	$1,104.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $917.30 / $1,104.81 / $1,851.02	Professional		$917.30	$1,104.81	$1,851.02
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,190.07 / $2,409.08 / $3,985.93	Facility		$2,190.07	$2,409.08	$3,985.93
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,971.06 / $2,036.77 / $2,693.78	Professional		$1,971.06	$2,036.77	$2,693.78
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,575.53 / $4,686.75 / $4,686.75	Facility		$1,575.53	$4,686.75	$4,686.75
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,222.54 / $4,835.84 / $9,141.95	Facility		$1,222.54	$4,835.84	$9,141.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $892.45 / $3,647.49 / $4,144.88	Professional		$892.45	$3,647.49	$4,144.88
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $630.14 / $1,657.22 / $2,518.58	Facility		$630.14	$1,657.22	$2,518.58
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,253.99 / $2,137.66 / $2,628.08	Professional		$1,253.99	$2,137.66	$2,628.08
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,090.80 / $2,190.07 / $10,198.75	Facility		$1,090.80	$2,190.07	$10,198.75
Medica Facility/Professional Professional Modifier Low / Median / High Price $989.19 / $1,463.36 / $2,384.71	Professional		$989.19	$1,463.36	$2,384.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $65.00 / $85.00	Professional		$50.00	$65.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $630.14 / $1,657.22 / $2,518.58	Facility		$630.14	$1,657.22	$2,518.58
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,253.99 / $2,137.66 / $2,628.08	Professional		$1,253.99	$2,137.66	$2,628.08
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,190.07 / $3,370.44 / $5,856.59	Professional		$2,190.07	$3,370.44	$5,856.59
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,222.54 / $4,277.47 / $10,198.75	Facility		$1,222.54	$4,277.47	$10,198.75
Quartz Facility/Professional Professional Modifier Low / Median / High Price $892.45 / $1,222.54 / $11,026.37	Professional		$892.45	$1,222.54	$11,026.37
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,190.07 / $2,190.07 / $2,190.07	Professional		$2,190.07	$2,190.07	$2,190.07
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,190.07 / $2,190.07 / $2,190.07	Professional		$2,190.07	$2,190.07	$2,190.07
United Facility/Professional Facility Modifier Low / Median / High Price $3,130.40 / $3,130.40 / $3,130.40	Facility		$3,130.40	$3,130.40	$3,130.40
United Facility/Professional Professional Modifier Low / Median / High Price $813.40 / $1,301.44 / $2,190.07	Professional		$813.40	$1,301.44	$2,190.07