Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,175.17 / $1,175.17 / $1,175.17	Facility		$1,175.17	$1,175.17	$1,175.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $975.67 / $1,175.17 / $1,968.83	Professional		$975.67	$1,175.17	$1,968.83
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,329.55 / $2,562.51 / $4,239.78	Facility		$2,329.55	$2,562.51	$4,239.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,166.48 / $2,166.48 / $2,865.34	Professional		$2,166.48	$2,166.48	$2,865.34
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,675.87 / $4,985.24 / $4,985.24	Facility		$1,675.87	$4,985.24	$4,985.24
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,800.00 / $6,948.00 / $9,724.17	Facility		$1,800.00	$6,948.00	$9,724.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,530.00 / $3,429.95 / $4,408.85	Professional		$1,530.00	$3,429.95	$4,408.85
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $670.42 / $1,762.76 / $2,678.98	Facility		$670.42	$1,762.76	$2,678.98
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,333.84 / $2,273.69 / $2,795.46	Professional		$1,333.84	$2,273.69	$2,795.46
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,160.52 / $2,329.55 / $10,007.20	Facility		$1,160.52	$2,329.55	$10,007.20
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,064.00 / $1,556.54 / $2,536.59	Professional		$1,064.00	$1,556.54	$2,536.59
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 $670.42 / $1,762.76 / $2,678.98	Facility		$670.42	$1,762.76	$2,678.98
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,333.84 / $2,273.69 / $2,795.46	Professional		$1,333.84	$2,273.69	$2,795.46
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,329.55 / $3,585.10 / $6,230.97	Professional		$2,329.55	$3,585.10	$6,230.97
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,800.00 / $4,549.89 / $10,007.20	Facility		$1,800.00	$4,549.89	$10,007.20
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,530.00 / $1,800.00 / $11,751.80	Professional		$1,530.00	$1,800.00	$11,751.80
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,329.55 / $2,329.55 / $2,329.55	Professional		$2,329.55	$2,329.55	$2,329.55
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,329.55 / $2,329.55 / $2,329.55	Professional		$2,329.55	$2,329.55	$2,329.55
United Facility/Professional Professional Modifier Low / Median / High Price $928.06 / $1,372.27 / $1,997.95	Professional		$928.06	$1,372.27	$1,997.95