Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,635.63 / $1,635.63 / $1,635.63	Facility		$1,635.63	$1,635.63	$1,635.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,324.12 / $1,635.63 / $2,715.77	Professional		$1,324.12	$1,635.63	$2,715.77
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,242.33 / $3,566.56 / $5,901.04	Facility		$3,242.33	$3,566.56	$5,901.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,918.09 / $3,015.37 / $3,988.06	Professional		$2,918.09	$3,015.37	$3,988.06
CareSource Facility/Professional Facility Modifier Low / Median / High Price $933.02 / $2,775.47 / $6,938.59	Facility		$933.02	$2,775.47	$6,938.59
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,808.29 / $6,703.53 / $13,533.78	Facility		$1,808.29	$6,703.53	$13,533.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,537.05 / $5,400.00 / $6,136.36	Professional		$1,537.05	$5,400.00	$6,136.36
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $932.06 / $2,453.44 / $3,728.68	Facility		$932.06	$2,453.44	$3,728.68
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,856.47 / $3,242.33 / $3,890.80	Professional		$1,856.47	$3,242.33	$3,890.80
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,613.42 / $3,242.33 / $15,133.20	Facility		$1,613.42	$3,242.33	$15,133.20
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,460.51 / $2,166.42 / $3,530.50	Professional		$1,460.51	$2,166.42	$3,530.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $85.00 / $2,066.71	Professional		$50.00	$85.00	$2,066.71
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $932.06 / $2,453.44 / $3,728.68	Facility		$932.06	$2,453.44	$3,728.68
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,856.47 / $3,242.33 / $3,890.80	Professional		$1,856.47	$3,242.33	$3,890.80
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,242.33 / $4,989.84 / $8,662.93	Professional		$3,242.33	$4,989.84	$8,662.93
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,808.29 / $6,332.68 / $15,133.20	Facility		$1,808.29	$6,332.68	$15,133.20
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,537.05 / $1,808.29 / $17,032.90	Professional		$1,537.05	$1,808.29	$17,032.90
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,242.33 / $3,242.33 / $3,242.33	Professional		$3,242.33	$3,242.33	$3,242.33
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,242.33 / $3,242.33 / $3,242.33	Professional		$3,242.33	$3,242.33	$3,242.33
United Facility/Professional Professional Modifier Low / Median / High Price $1,291.70 / $2,156.75 / $2,874.70	Professional		$1,291.70	$2,156.75	$2,874.70