Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,193.69 / $1,193.69 / $1,193.69	Facility		$1,193.69	$1,193.69	$1,193.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $739.29 / $1,193.69 / $1,981.98	Professional		$739.29	$1,193.69	$1,981.98
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,366.26 / $2,602.89 / $4,306.59	Facility		$2,366.26	$2,602.89	$4,306.59
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,129.63 / $2,200.62 / $2,910.49	Professional		$2,129.63	$2,200.62	$2,910.49
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,702.28 / $5,063.80 / $5,063.80	Facility		$1,702.28	$5,063.80	$5,063.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,530.70 / $4,892.09 / $9,876.71	Facility		$1,530.70	$4,892.09	$9,876.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,117.41 / $3,940.95 / $4,478.35	Professional		$1,117.41	$3,940.95	$4,478.35
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $571.58 / $1,790.54 / $2,721.20	Facility		$571.58	$1,790.54	$2,721.20
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,354.86 / $2,366.26 / $2,839.51	Professional		$1,354.86	$2,366.26	$2,839.51
Medica Facility/Professional Facility Modifier Low / Median / High Price $989.43 / $2,357.19 / $9,406.52	Facility		$989.43	$2,357.19	$9,406.52
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,064.92 / $1,333.99 / $2,576.57	Professional		$1,064.92	$1,333.99	$2,576.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,182.05	Professional		$50.00	$70.00	$1,182.05
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $571.58 / $1,790.54 / $2,721.20	Facility		$571.58	$1,790.54	$2,721.20
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,354.86 / $2,366.26 / $2,839.51	Professional		$1,354.86	$2,366.26	$2,839.51
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,366.26 / $3,549.39 / $5,312.58	Professional		$2,366.26	$3,549.39	$5,312.58
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,530.70 / $4,621.62 / $9,406.52	Facility		$1,530.70	$4,621.62	$9,406.52
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,117.41 / $1,530.70 / $13,412.66	Professional		$1,117.41	$1,530.70	$13,412.66
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,366.26 / $2,366.26 / $2,366.26	Professional		$2,366.26	$2,366.26	$2,366.26
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,366.26 / $2,366.26 / $2,366.26	Professional		$2,366.26	$2,366.26	$2,366.26
United Facility/Professional Professional Modifier Low / Median / High Price $787.00 / $1,270.19 / $2,097.96	Professional		$787.00	$1,270.19	$2,097.96