Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,392.96 / $1,392.96 / $1,392.96	Facility		$1,392.96	$1,392.96	$1,392.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,156.49 / $1,392.96 / $2,333.69	Professional		$1,156.49	$1,392.96	$2,333.69
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,761.27 / $3,037.40 / $5,025.51	Facility		$2,761.27	$3,037.40	$5,025.51
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,485.14 / $2,567.98 / $3,396.36	Professional		$2,485.14	$2,567.98	$3,396.36
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,986.46 / $5,909.12 / $5,909.12	Facility		$1,986.46	$5,909.12	$5,909.12
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,786.24 / $6,096.17 / $11,525.41	Facility		$1,786.24	$6,096.17	$11,525.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,303.96 / $4,065.27 / $5,225.91	Professional		$1,303.96	$4,065.27	$5,225.91
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $794.47 / $2,089.44 / $3,175.46	Facility		$794.47	$2,089.44	$3,175.46
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,581.04 / $2,695.08 / $3,313.52	Professional		$1,581.04	$2,695.08	$3,313.52
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,375.25 / $2,761.27 / $12,858.35	Facility		$1,375.25	$2,761.27	$12,858.35
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,260.85 / $1,845.00 / $3,006.68	Professional		$1,260.85	$1,845.00	$3,006.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $169.76	Professional		$50.00	$70.00	$169.76
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $794.47 / $2,089.44 / $3,175.46	Facility		$794.47	$2,089.44	$3,175.46
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,581.04 / $2,695.08 / $3,313.52	Professional		$1,581.04	$2,695.08	$3,313.52
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,761.27 / $4,249.52 / $7,384.22	Professional		$2,761.27	$4,249.52	$7,384.22
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,786.24 / $5,393.10 / $12,858.35	Facility		$1,786.24	$5,393.10	$12,858.35
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,303.96 / $1,786.24 / $13,901.92	Professional		$1,303.96	$1,786.24	$13,901.92
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,761.27 / $2,761.27 / $2,761.27	Professional		$2,761.27	$2,761.27	$2,761.27
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,761.27 / $2,761.27 / $2,761.27	Professional		$2,761.27	$2,761.27	$2,761.27
United Facility/Professional Professional Modifier Low / Median / High Price $1,100.06 / $1,656.76 / $2,761.27	Professional		$1,100.06	$1,656.76	$2,761.27