Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,432.35 / $1,432.35 / $1,432.35	Facility		$1,432.35	$1,432.35	$1,432.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,189.20 / $1,432.35 / $2,399.71	Professional		$1,189.20	$1,432.35	$2,399.71
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,839.36 / $3,123.30 / $5,167.64	Facility		$2,839.36	$3,123.30	$5,167.64
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,455.75 / $2,640.60 / $3,492.41	Professional		$2,455.75	$2,640.60	$3,492.41
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,042.62 / $6,076.23 / $6,076.23	Facility		$2,042.62	$6,076.23	$6,076.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,584.92 / $6,269.48 / $11,851.51	Facility		$1,584.92	$6,269.48	$11,851.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,156.99 / $4,180.52 / $5,373.70	Professional		$1,156.99	$4,180.52	$5,373.70
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $857.77 / $2,271.48 / $3,265.26	Facility		$857.77	$2,271.48	$3,265.26
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $2,771.24 / $2,839.36 / $3,407.23	Professional		$2,771.24	$2,839.36	$3,407.23
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,432.35 / $2,839.36 / $13,221.84	Facility		$1,432.35	$2,839.36	$13,221.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,303.25 / $1,904.25 / $3,107.93	Professional		$1,303.25	$1,904.25	$3,107.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $423.00	Professional		$50.00	$70.00	$423.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $857.77 / $2,271.48 / $3,265.26	Facility		$857.77	$2,271.48	$3,265.26
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $2,771.24 / $2,839.36 / $3,407.23	Professional		$2,771.24	$2,839.36	$3,407.23
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,839.36 / $4,369.66 / $7,592.99	Professional		$2,839.36	$4,369.66	$7,592.99
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,584.92 / $5,545.62 / $13,221.84	Facility		$1,584.92	$5,545.62	$13,221.84
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,156.99 / $1,584.92 / $14,294.89	Professional		$1,156.99	$1,584.92	$14,294.89
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,839.36 / $2,839.36 / $2,839.36	Professional		$2,839.36	$2,839.36	$2,839.36
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,839.36 / $2,839.36 / $2,839.36	Professional		$2,839.36	$2,839.36	$2,839.36
United Facility/Professional Professional Modifier Low / Median / High Price $1,054.51 / $1,703.62 / $2,517.42	Professional		$1,054.51	$1,703.62	$2,517.42