Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $4,320.00 / $4,320.00 / $8,028.00	Facility		$4,320.00	$4,320.00	$8,028.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,772.00 / $3,600.00 / $4,320.00	Professional		$2,772.00	$3,600.00	$4,320.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $7,740.00 / $9,360.00 / $9,900.00	Facility		$7,740.00	$9,360.00	$9,900.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,440.00 / $1,440.00 / $15,419.56	Professional		$1,440.00	$1,440.00	$15,419.56
CareSource Facility/Professional Facility Modifier Low / Median / High Price $9,144.00 / $9,144.00 / $9,144.00	Facility		$9,144.00	$9,144.00	$9,144.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $9,906.91 / $11,577.01 / $17,759.43	Facility		$9,906.91	$11,577.01	$17,759.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $4,136.60 / $9,694.08 / $11,016.00	Professional		$4,136.60	$9,694.08	$11,016.00
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $2,772.00 / $4,320.00 / $12,600.00	Facility		$2,772.00	$4,320.00	$12,600.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $2,772.00 / $4,320.00 / $12,600.00	Facility		$2,772.00	$4,320.00	$12,600.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,800.00 / $2,160.00 / $11,101.86	Professional		$1,800.00	$2,160.00	$11,101.86
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $3,600.00	Professional		$50.00	$70.00	$3,600.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $2,772.00 / $4,320.00 / $12,600.00	Facility		$2,772.00	$4,320.00	$12,600.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $6,468.17 / $8,583.79 / $12,039.35	Professional		$6,468.17	$8,583.79	$12,039.35
Quartz Facility/Professional Facility Modifier Low / Median / High Price $7,200.00 / $17,100.00 / $17,100.00	Facility		$7,200.00	$17,100.00	$17,100.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,427.03 / $14,400.00 / $17,928.00	Professional		$3,427.03	$14,400.00	$17,928.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,600.00 / $3,600.00 / $7,666.36	Professional		$3,600.00	$3,600.00	$7,666.36
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,600.00 / $10,461.60 / $19,656.00	Professional		$3,600.00	$10,461.60	$19,656.00
United Facility/Professional Facility Modifier Low / Median / High Price $2,880.00 / $2,880.00 / $7,812.00	Facility		$2,880.00	$2,880.00	$7,812.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,620.00 / $2,305.08 / $6,701.04	Professional		$1,620.00	$2,305.08	$6,701.04