Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,491.24 / $1,491.24 / $1,491.24	Facility		$1,491.24	$1,491.24	$1,491.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,053.90 / $1,491.24 / $2,476.02	Professional		$1,053.90	$1,491.24	$2,476.02
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,956.10 / $3,251.71 / $5,380.10	Facility		$2,956.10	$3,251.71	$5,380.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,660.49 / $2,749.17 / $3,636.00	Professional		$2,660.49	$2,749.17	$3,636.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,126.60 / $6,326.05 / $6,326.05	Facility		$2,126.60	$6,326.05	$6,326.05
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,523.27 / $6,111.61 / $12,338.56	Facility		$1,523.27	$6,111.61	$12,338.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,111.99 / $4,283.91 / $5,594.66	Professional		$1,111.99	$4,283.91	$5,594.66
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $785.15 / $2,236.86 / $3,399.52	Facility		$785.15	$2,236.86	$3,399.52
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,692.58 / $2,956.10 / $3,547.32	Professional		$1,692.58	$2,956.10	$3,547.32
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,359.12 / $2,956.10 / $12,771.35	Facility		$1,359.12	$2,956.10	$12,771.35
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,331.58 / $1,832.01 / $3,218.83	Professional		$1,331.58	$1,832.01	$3,218.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,096.64	Professional		$50.00	$70.00	$1,096.64
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $785.15 / $2,236.86 / $3,399.52	Facility		$785.15	$2,236.86	$3,399.52
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,692.58 / $2,956.10 / $3,547.32	Professional		$1,692.58	$2,956.10	$3,547.32
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,956.10 / $4,549.32 / $7,296.90	Professional		$2,956.10	$4,549.32	$7,296.90
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,523.27 / $5,773.64 / $12,771.35	Facility		$1,523.27	$5,773.64	$12,771.35
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,111.99 / $1,523.27 / $15,761.88	Professional		$1,111.99	$1,523.27	$15,761.88
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,956.10 / $2,956.10 / $2,956.10	Professional		$2,956.10	$2,956.10	$2,956.10
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,956.10 / $2,956.10 / $2,956.10	Professional		$2,956.10	$2,956.10	$2,956.10
United Facility/Professional Facility Modifier Low / Median / High Price $1,624.58 / $1,624.58 / $1,624.58	Facility		$1,624.58	$1,624.58	$1,624.58
United Facility/Professional Professional Modifier Low / Median / High Price $983.17 / $1,621.58 / $2,620.92	Professional		$983.17	$1,621.58	$2,620.92