Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,531.92 / $1,531.92 / $1,531.92	Facility		$1,531.92	$1,531.92	$1,531.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $962.28 / $1,531.92 / $2,543.56	Professional		$962.28	$1,531.92	$2,543.56
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,036.73 / $3,340.40 / $5,526.85	Facility		$3,036.73	$3,340.40	$5,526.85
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,626.46 / $2,824.16 / $3,735.17	Professional		$2,626.46	$2,824.16	$3,735.17
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,184.62 / $6,498.60 / $6,498.60	Facility		$2,184.62	$6,498.60	$6,498.60
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,964.43 / $6,278.57 / $12,675.85	Facility		$1,964.43	$6,278.57	$12,675.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,434.03 / $4,400.63 / $5,747.25	Professional		$1,434.03	$4,400.63	$5,747.25
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $743.99 / $2,297.88 / $3,492.24	Facility		$743.99	$2,297.88	$3,492.24
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,738.76 / $2,521.80 / $3,644.08	Professional		$1,738.76	$2,521.80	$3,644.08
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,287.86 / $3,036.73 / $12,160.93	Facility		$1,287.86	$3,036.73	$12,160.93
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,331.90 / $1,736.36 / $3,306.63	Professional		$1,331.90	$1,736.36	$3,306.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,057.63	Professional		$50.00	$70.00	$1,057.63
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $743.99 / $2,297.88 / $3,492.24	Facility		$743.99	$2,297.88	$3,492.24
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,738.76 / $2,521.80 / $3,644.08	Professional		$1,738.76	$2,521.80	$3,644.08
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,036.73 / $4,555.10 / $6,914.49	Professional		$3,036.73	$4,555.10	$6,914.49
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,964.43 / $5,931.12 / $12,160.93	Facility		$1,964.43	$5,931.12	$12,160.93
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,434.03 / $1,964.43 / $14,783.95	Professional		$1,434.03	$1,964.43	$14,783.95
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,036.73 / $3,036.73 / $3,036.73	Professional		$3,036.73	$3,036.73	$3,036.73
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,424.75 / $3,036.73 / $3,036.73	Professional		$2,424.75	$3,036.73	$3,036.73
United Facility/Professional Professional Modifier Low / Median / High Price $1,010.00 / $1,616.75 / $2,692.42	Professional		$1,010.00	$1,616.75	$2,692.42