Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,026.75 / $1,026.75 / $1,026.75	Facility		$1,026.75	$1,026.75	$1,026.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $918.79 / $1,026.75 / $1,854.04	Professional		$918.79	$1,026.75	$1,854.04
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,035.34 / $2,238.87 / $3,704.32	Facility		$2,035.34	$2,238.87	$3,704.32
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,831.80 / $1,892.87 / $2,503.46	Professional		$1,831.80	$1,892.87	$2,503.46
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,464.23 / $4,355.63 / $4,355.63	Facility		$1,464.23	$4,355.63	$4,355.63
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,316.65 / $4,208.22 / $8,495.35	Facility		$1,316.65	$4,208.22	$8,495.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $961.15 / $2,949.38 / $3,852.05	Professional		$961.15	$2,949.38	$3,852.05
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $572.38 / $1,540.13 / $2,340.64	Facility		$572.38	$1,540.13	$2,340.64
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,165.39 / $1,953.16 / $2,442.41	Professional		$1,165.39	$1,953.16	$2,442.41
Medica Facility/Professional Facility Modifier Low / Median / High Price $990.81 / $2,035.34 / $9,399.59	Facility		$990.81	$2,035.34	$9,399.59
Medica Facility/Professional Professional Modifier Low / Median / High Price $900.79 / $1,335.55 / $2,216.23	Professional		$900.79	$1,335.55	$2,216.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,238.50	Professional		$50.00	$70.00	$1,238.50
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $572.38 / $1,540.13 / $2,340.64	Facility		$572.38	$1,540.13	$2,340.64
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,165.39 / $1,953.16 / $2,442.41	Professional		$1,165.39	$1,953.16	$2,442.41
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,035.34 / $3,132.34 / $5,319.61	Professional		$2,035.34	$3,132.34	$5,319.61
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,316.65 / $3,975.28 / $9,399.59	Facility		$1,316.65	$3,975.28	$9,399.59
Quartz Facility/Professional Professional Modifier Low / Median / High Price $961.15 / $1,316.65 / $11,373.79	Professional		$961.15	$1,316.65	$11,373.79
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,035.34 / $2,035.34 / $2,035.34	Professional		$2,035.34	$2,035.34	$2,035.34
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,035.34 / $2,035.34 / $2,035.34	Professional		$2,035.34	$2,035.34	$2,035.34
United Facility/Professional Professional Modifier Low / Median / High Price $738.84 / $1,182.14 / $1,804.57	Professional		$738.84	$1,182.14	$1,804.57