Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,655.22 / $1,655.22 / $1,655.22	Facility		$1,655.22	$1,655.22	$1,655.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,177.60 / $1,655.22 / $2,748.28	Professional		$1,177.60	$1,655.22	$2,748.28
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,281.15 / $3,609.27 / $5,971.69	Facility		$3,281.15	$3,609.27	$5,971.69
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,585.56 / $3,051.47 / $4,035.81	Professional		$2,585.56	$3,051.47	$4,035.81
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,360.44 / $7,021.66 / $7,021.66	Facility		$2,360.44	$7,021.66	$7,021.66
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,283.76 / $7,244.26 / $13,696.13	Facility		$2,283.76	$7,244.26	$13,696.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,667.14 / $4,831.08 / $6,209.84	Professional		$1,667.14	$4,831.08	$6,209.84
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $863.01 / $2,482.83 / $3,773.32	Facility		$863.01	$2,482.83	$3,773.32
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,878.71 / $3,281.15 / $3,937.38	Professional		$1,878.71	$3,281.15	$3,937.38
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,493.91 / $3,281.15 / $14,087.74	Facility		$1,493.91	$3,281.15	$14,087.74
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,478.00 / $2,013.70 / $3,572.77	Professional		$1,478.00	$2,013.70	$3,572.77
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 $863.01 / $2,482.83 / $3,773.32	Facility		$863.01	$2,482.83	$3,773.32
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,878.71 / $3,281.15 / $3,937.38	Professional		$1,878.71	$3,281.15	$3,937.38
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,281.15 / $5,049.56 / $8,021.57	Professional		$3,281.15	$5,049.56	$8,021.57
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,283.76 / $6,408.50 / $14,087.74	Facility		$2,283.76	$6,408.50	$14,087.74
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,667.14 / $2,283.76 / $18,640.13	Professional		$1,667.14	$2,283.76	$18,640.13
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,281.15 / $3,281.15 / $3,281.15	Professional		$3,281.15	$3,281.15	$3,281.15
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,281.15 / $3,281.15 / $3,281.15	Professional		$3,281.15	$3,281.15	$3,281.15
United Facility/Professional Professional Modifier Low / Median / High Price $1,114.00 / $1,968.69 / $2,909.12	Professional		$1,114.00	$1,968.69	$2,909.12