Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,229.52 / $1,229.52 / $1,229.52	Facility		$1,229.52	$1,229.52	$1,229.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $835.48 / $1,229.52 / $2,041.47	Professional		$835.48	$1,229.52	$2,041.47
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,437.29 / $2,681.02 / $4,435.87	Facility		$2,437.29	$2,681.02	$4,435.87
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,206.17 / $2,266.67 / $2,997.86	Professional		$2,206.17	$2,266.67	$2,997.86
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,753.39 / $5,215.80 / $5,215.80	Facility		$1,753.39	$5,215.80	$5,215.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,576.65 / $5,038.42 / $10,173.43	Facility		$1,576.65	$5,038.42	$10,173.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,150.95 / $3,532.03 / $4,612.78	Professional		$1,150.95	$3,532.03	$4,612.78
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $604.26 / $1,844.28 / $2,802.88	Facility		$604.26	$1,844.28	$2,802.88
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,395.53 / $2,144.98 / $2,924.75	Professional		$1,395.53	$2,144.98	$2,924.75
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,046.01 / $2,437.29 / $9,757.10	Facility		$1,046.01	$2,437.29	$9,757.10
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,007.18 / $1,410.27 / $2,653.91	Professional		$1,007.18	$1,410.27	$2,653.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,644.81	Professional		$50.00	$70.00	$1,644.81
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $604.26 / $1,844.28 / $2,802.88	Facility		$604.26	$1,844.28	$2,802.88
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,395.53 / $2,144.98 / $2,924.75	Professional		$1,395.53	$2,144.98	$2,924.75
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,437.29 / $3,655.94 / $5,615.70	Professional		$2,437.29	$3,655.94	$5,615.70
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,576.65 / $4,760.34 / $9,757.10	Facility		$1,576.65	$4,760.34	$9,757.10
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,150.95 / $1,576.65 / $11,243.79	Professional		$1,150.95	$1,576.65	$11,243.79
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,437.29 / $2,437.29 / $2,437.29	Professional		$2,437.29	$2,437.29	$2,437.29
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,437.29 / $2,437.29 / $2,437.29	Professional		$2,437.29	$2,437.29	$2,437.29
United Facility/Professional Professional Modifier Low / Median / High Price $845.97 / $1,215.94 / $2,090.36	Professional		$845.97	$1,215.94	$2,090.36