Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,339.67 / $1,339.67 / $1,339.67	Facility		$1,339.67	$1,339.67	$1,339.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,130.47 / $1,339.67 / $2,281.19	Professional		$1,130.47	$1,339.67	$2,281.19
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,655.63 / $2,921.19 / $4,833.25	Facility		$2,655.63	$2,921.19	$4,833.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,469.73 / $2,469.73 / $3,266.42	Professional		$2,469.73	$2,469.73	$3,266.42
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,910.44 / $5,683.05 / $5,683.05	Facility		$1,910.44	$5,683.05	$5,683.05
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,482.94 / $7,920.00 / $11,084.55	Facility		$1,482.94	$7,920.00	$11,084.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,260.50 / $3,910.01 / $5,025.99	Professional		$1,260.50	$3,910.01	$5,025.99
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $764.36 / $2,009.51 / $3,053.97	Facility		$764.36	$2,009.51	$3,053.97
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,520.54 / $2,655.63 / $3,186.76	Professional		$1,520.54	$2,655.63	$3,186.76
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,323.14 / $2,655.63 / $11,409.47	Facility		$1,323.14	$2,655.63	$11,409.47
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,202.90 / $1,774.41 / $2,891.65	Professional		$1,202.90	$1,774.41	$2,891.65
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 $764.36 / $2,009.51 / $3,053.97	Facility		$764.36	$2,009.51	$3,053.97
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,520.54 / $2,655.63 / $3,186.76	Professional		$1,520.54	$2,655.63	$3,186.76
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,655.63 / $4,086.90 / $7,104.19	Professional		$2,655.63	$4,086.90	$7,104.19
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,482.94 / $5,186.78 / $11,409.47	Facility		$1,482.94	$5,186.78	$11,409.47
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,260.50 / $1,482.94 / $13,194.36	Professional		$1,260.50	$1,482.94	$13,194.36
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,655.63 / $2,655.63 / $2,655.63	Professional		$2,655.63	$2,655.63	$2,655.63
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,655.63 / $2,655.63 / $2,655.63	Professional		$2,655.63	$2,655.63	$2,655.63
United Facility/Professional Professional Modifier Low / Median / High Price $1,057.96 / $1,578.65 / $2,277.61	Professional		$1,057.96	$1,578.65	$2,277.61