Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,529.05 / $1,529.05 / $1,529.05	Facility		$1,529.05	$1,529.05	$1,529.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,186.74 / $1,529.05 / $2,538.80	Professional		$1,186.74	$1,529.05	$2,538.80
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,031.05 / $3,334.16 / $5,516.51	Facility		$3,031.05	$3,334.16	$5,516.51
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,727.94 / $2,818.88 / $3,728.19	Professional		$2,727.94	$2,818.88	$3,728.19
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,180.53 / $6,486.45 / $6,486.45	Facility		$2,180.53	$6,486.45	$6,486.45
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,960.76 / $6,266.38 / $12,652.06	Facility		$1,960.76	$6,266.38	$12,652.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,431.35 / $4,392.18 / $5,736.50	Professional		$1,431.35	$4,392.18	$5,736.50
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $791.23 / $2,293.58 / $3,485.71	Facility		$791.23	$2,293.58	$3,485.71
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,735.50 / $2,681.85 / $3,637.26	Professional		$1,735.50	$2,681.85	$3,637.26
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,369.65 / $3,031.05 / $12,853.25	Facility		$1,369.65	$3,031.05	$12,853.25
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,242.71 / $1,846.20 / $3,300.44	Professional		$1,242.71	$1,846.20	$3,300.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $2,045.51	Professional		$50.00	$70.00	$2,045.51
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $791.23 / $2,293.58 / $3,485.71	Facility		$791.23	$2,293.58	$3,485.71
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,735.50 / $2,681.85 / $3,637.26	Professional		$1,735.50	$2,681.85	$3,637.26
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,031.05 / $4,664.68 / $7,354.11	Professional		$3,031.05	$4,664.68	$7,354.11
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,960.76 / $5,920.02 / $12,853.25	Facility		$1,960.76	$5,920.02	$12,853.25
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,431.35 / $1,960.76 / $14,449.94	Professional		$1,431.35	$1,960.76	$14,449.94
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,031.05 / $3,031.05 / $3,031.05	Professional		$3,031.05	$3,031.05	$3,031.05
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,031.05 / $3,031.05 / $3,031.05	Professional		$3,031.05	$3,031.05	$3,031.05
United Facility/Professional Professional Modifier Low / Median / High Price $1,021.34 / $1,619.56 / $3,031.05	Professional		$1,021.34	$1,619.56	$3,031.05