Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,620.67 / $1,620.67 / $1,620.67	Facility		$1,620.67	$1,620.67	$1,620.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,020.66 / $1,620.67 / $2,690.92	Professional		$1,020.66	$1,620.67	$2,690.92
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,212.66 / $3,533.93 / $5,847.04	Facility		$3,212.66	$3,533.93	$5,847.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,778.62 / $2,987.77 / $3,951.57	Professional		$2,778.62	$2,987.77	$3,951.57
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,311.19 / $6,875.09 / $6,875.09	Facility		$2,311.19	$6,875.09	$6,875.09
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,787.17 / $6,641.61 / $13,409.22	Facility		$1,787.17	$6,641.61	$13,409.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,304.63 / $5,350.58 / $6,080.20	Professional		$1,304.63	$5,350.58	$6,080.20
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $789.12 / $2,431.01 / $3,694.56	Facility		$789.12	$2,431.01	$3,694.56
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,839.48 / $3,212.66 / $3,855.19	Professional		$1,839.48	$3,212.66	$3,855.19
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,366.01 / $3,212.66 / $13,048.73	Facility		$1,366.01	$3,212.66	$13,048.73
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,412.70 / $1,841.70 / $3,498.19	Professional		$1,412.70	$1,841.70	$3,498.19
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 $789.12 / $2,431.01 / $3,694.56	Facility		$789.12	$2,431.01	$3,694.56
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,839.48 / $3,212.66 / $3,855.19	Professional		$1,839.48	$3,212.66	$3,855.19
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,212.66 / $4,818.99 / $7,334.04	Professional		$3,212.66	$4,818.99	$7,334.04
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,787.17 / $6,274.72 / $13,048.73	Facility		$1,787.17	$6,274.72	$13,048.73
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,304.63 / $1,787.17 / $15,680.88	Professional		$1,304.63	$1,787.17	$15,680.88
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,212.66 / $3,212.66 / $3,212.66	Professional		$3,212.66	$3,212.66	$3,212.66
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,212.66 / $3,212.66 / $3,212.66	Professional		$3,212.66	$3,212.66	$3,212.66
United Facility/Professional Facility Modifier Low / Median / High Price $1,448.21 / $1,448.21 / $1,448.21	Facility		$1,448.21	$1,448.21	$1,448.21
United Facility/Professional Professional Modifier Low / Median / High Price $1,068.51 / $1,629.79 / $2,755.36	Professional		$1,068.51	$1,629.79	$2,755.36