Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,922.69 / $1,922.69 / $1,922.69	Facility		$1,922.69	$1,922.69	$1,922.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,596.31 / $1,922.69 / $3,221.22	Professional		$1,596.31	$1,922.69	$3,221.22
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,811.37 / $4,192.51 / $6,936.69	Facility		$3,811.37	$4,192.51	$6,936.69
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,504.88 / $3,544.57 / $4,687.97	Professional		$3,504.88	$3,544.57	$4,687.97
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,741.89 / $8,156.33 / $8,156.33	Facility		$2,741.89	$8,156.33	$8,156.33
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,381.07 / $7,544.05 / $15,908.84	Facility		$2,381.07	$7,544.05	$15,908.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,738.18 / $5,523.28 / $7,213.31	Professional		$1,738.18	$5,523.28	$7,213.31
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,922.69 / $3,034.11 / $4,383.08	Facility		$1,922.69	$3,034.11	$4,383.08
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $3,719.97 / $3,811.37 / $4,573.64	Professional		$3,719.97	$3,811.37	$4,573.64
Medica Facility/Professional Facility Modifier Low / Median / High Price $2,494.36 / $3,811.37 / $17,752.32	Facility		$2,494.36	$3,811.37	$17,752.32
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,758.04 / $2,559.92 / $4,245.52	Professional		$1,758.04	$2,559.92	$4,245.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $65.00 / $85.00	Professional		$50.00	$65.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,922.69 / $3,049.10 / $4,383.08	Facility		$1,922.69	$3,049.10	$4,383.08
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $3,719.97 / $3,811.37 / $4,573.64	Professional		$3,719.97	$3,811.37	$4,573.64
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,811.37 / $5,865.56 / $10,194.58	Professional		$3,811.37	$5,865.56	$10,194.58
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,381.07 / $7,444.08 / $17,752.32	Facility		$2,381.07	$7,444.08	$17,752.32
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,738.18 / $2,381.07 / $19,227.03	Professional		$1,738.18	$2,381.07	$19,227.03
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,811.37 / $3,811.37 / $3,811.37	Professional		$3,811.37	$3,811.37	$3,811.37
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,811.37 / $3,811.37 / $3,811.37	Professional		$3,811.37	$3,811.37	$3,811.37
United Facility/Professional Professional Modifier Low / Median / High Price $1,518.40 / $2,265.37 / $3,811.37	Professional		$1,518.40	$2,265.37	$3,811.37