Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $4,200.00 / $4,200.00 / $4,200.00	Facility		$4,200.00	$4,200.00	$4,200.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,695.00 / $3,290.00 / $4,200.00	Professional		$2,695.00	$3,290.00	$4,200.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $239.16 / $239.16 / $14,991.24	Professional		$239.16	$239.16	$14,991.24
CareSource Facility/Professional Facility Modifier Low / Median / High Price $5,325.55 / $5,325.55 / $5,325.55	Facility		$5,325.55	$5,325.55	$5,325.55
Cigna Facility/Professional Facility Modifier Low / Median / High Price $9,632.07 / $11,255.84 / $17,266.74	Facility		$9,632.07	$11,255.84	$17,266.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $4,142.45 / $9,424.79 / $10,710.00	Professional		$4,142.45	$9,424.79	$10,710.00
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $2,695.00 / $4,200.00 / $12,250.00	Facility		$2,695.00	$4,200.00	$12,250.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $2,695.00 / $4,200.00 / $12,250.00	Facility		$2,695.00	$4,200.00	$12,250.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,750.00 / $2,100.00 / $10,793.48	Professional		$1,750.00	$2,100.00	$10,793.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $85.00	Professional		$50.00	$70.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $2,695.00 / $4,200.00 / $12,250.00	Facility		$2,695.00	$4,200.00	$12,250.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $5,842.80 / $8,345.46 / $11,705.08	Professional		$5,842.80	$8,345.46	$11,705.08
Quartz Facility/Professional Facility Modifier Low / Median / High Price $7,000.00 / $16,625.00 / $16,625.00	Facility		$7,000.00	$16,625.00	$16,625.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $14,000.00 / $14,000.00 / $17,430.00	Professional		$14,000.00	$14,000.00	$17,430.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $7,453.40 / $7,453.40 / $7,453.40	Professional		$7,453.40	$7,453.40	$7,453.40
Security Health Facility/Professional Professional Modifier Low / Median / High Price $19,110.00 / $19,110.00 / $19,110.00	Professional		$19,110.00	$19,110.00	$19,110.00
United Facility/Professional Facility Modifier Low / Median / High Price $3,500.00 / $3,500.00 / $3,500.00	Facility		$3,500.00	$3,500.00	$3,500.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,575.00 / $2,100.00 / $7,350.00	Professional		$1,575.00	$2,100.00	$7,350.00