Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,513.80 / $1,513.80 / $1,513.80	Facility		$1,513.80	$1,513.80	$1,513.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $949.79 / $1,513.80 / $2,513.48	Professional		$949.79	$1,513.80	$2,513.48
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,000.82 / $3,300.90 / $5,461.49	Facility		$3,000.82	$3,300.90	$5,461.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,595.40 / $2,790.76 / $3,691.00	Professional		$2,595.40	$2,790.76	$3,691.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,158.79 / $6,421.75 / $6,421.75	Facility		$2,158.79	$6,421.75	$6,421.75
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,424.68 / $6,203.53 / $12,526.10	Facility		$1,424.68	$6,203.53	$12,526.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,040.02 / $4,997.77 / $5,679.29	Professional		$1,040.02	$4,997.77	$5,679.29
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $734.33 / $2,270.69 / $3,450.94	Facility		$734.33	$2,270.69	$3,450.94
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,718.20 / $3,000.82 / $3,600.98	Professional		$1,718.20	$3,000.82	$3,600.98
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,271.15 / $3,000.82 / $12,107.67	Facility		$1,271.15	$3,000.82	$12,107.67
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,314.60 / $1,713.81 / $3,267.53	Professional		$1,314.60	$1,713.81	$3,267.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,512.84	Professional		$50.00	$70.00	$1,512.84
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $734.33 / $2,270.69 / $3,450.94	Facility		$734.33	$2,270.69	$3,450.94
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,718.20 / $3,000.82 / $3,600.98	Professional		$1,718.20	$3,000.82	$3,600.98
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,000.82 / $4,501.22 / $6,825.16	Professional		$3,000.82	$4,501.22	$6,825.16
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,424.68 / $5,860.98 / $12,107.67	Facility		$1,424.68	$5,860.98	$12,107.67
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,040.02 / $1,424.68 / $14,545.68	Professional		$1,040.02	$1,424.68	$14,545.68
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,000.82 / $3,000.82 / $3,000.82	Professional		$3,000.82	$3,000.82	$3,000.82
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,000.82 / $3,000.82 / $3,000.82	Professional		$3,000.82	$3,000.82	$3,000.82
United Facility/Professional Professional Modifier Low / Median / High Price $998.05 / $1,713.44 / $3,000.82	Professional		$998.05	$1,713.44	$3,000.82