Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,988.80 / $4,986.00 / $7,412.52	Facility		$3,988.80	$4,986.00	$7,412.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,659.20 / $3,124.56 / $3,988.80	Professional		$2,659.20	$3,124.56	$3,988.80
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $7,146.60 / $8,642.40 / $9,141.00	Facility		$7,146.60	$8,642.40	$9,141.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,329.60 / $2,293.56 / $14,237.40	Professional		$1,329.60	$2,293.56	$14,237.40
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,501.31 / $8,123.55 / $8,442.95	Facility		$2,501.31	$8,123.55	$8,442.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $9,147.27 / $10,689.31 / $16,397.66	Facility		$9,147.27	$10,689.31	$16,397.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $3,819.42 / $8,950.87 / $10,171.44	Professional		$3,819.42	$8,950.87	$10,171.44
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,994.40 / $2,991.60 / $6,535.12	Facility		$1,994.40	$2,991.60	$6,535.12
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,994.40 / $3,124.56 / $15,789.00	Facility		$1,994.40	$3,124.56	$15,789.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,662.00 / $2,659.20 / $9,207.48	Professional		$1,662.00	$2,659.20	$9,207.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $55.00 / $85.00 / $3,324.00	Professional		$55.00	$85.00	$3,324.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,994.40 / $2,991.60 / $6,535.12	Facility		$1,994.40	$2,991.60	$6,535.12
Quartz Facility/Professional Professional Modifier Low / Median / High Price $5,549.04 / $7,925.88 / $11,116.58	Professional		$5,549.04	$7,925.88	$11,116.58
Quartz Facility/Professional Facility Modifier Low / Median / High Price $6,648.00 / $6,648.00 / $15,789.00	Facility		$6,648.00	$6,648.00	$15,789.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,761.72 / $16,620.00 / $16,620.00	Professional		$1,761.72	$16,620.00	$16,620.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $7,078.60 / $7,078.60 / $7,078.60	Professional		$7,078.60	$7,078.60	$7,078.60
Security Health Facility/Professional Professional Modifier Low / Median / High Price $9,660.26 / $18,149.04 / $18,149.04	Professional		$9,660.26	$18,149.04	$18,149.04
United Facility/Professional Facility Modifier Low / Median / High Price $3,988.80 / $3,988.80 / $3,988.80	Facility		$3,988.80	$3,988.80	$3,988.80
United Facility/Professional Professional Modifier Low / Median / High Price $1,662.00 / $2,128.36 / $6,187.29	Professional		$1,662.00	$2,128.36	$6,187.29