Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,683.00 / $2,683.00 / $2,683.00	Facility		$2,683.00	$2,683.00	$2,683.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,543.63 / $2,683.00 / $10,562.30	Professional		$2,543.63	$2,683.00	$10,562.30
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $5,795.10 / $5,795.10 / $9,561.92	Facility		$5,795.10	$5,795.10	$9,561.92
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,404.55 / $5,012.17 / $5,795.10	Professional		$3,404.55	$5,012.17	$5,795.10
CareSource Facility/Professional Facility Modifier Low / Median / High Price $521.55 / $1,240.15 / $7,834.13	Facility		$521.55	$1,240.15	$7,834.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $9,838.43 / $11,496.98 / $17,636.66	Facility		$9,838.43	$11,496.98	$17,636.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,275.00 / $4,371.18 / $5,304.84	Professional		$1,275.00	$4,371.18	$5,304.84
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $2,543.63 / $3,660.81 / $3,843.85	Facility		$2,543.63	$3,660.81	$3,843.85
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,313.65 / $1,313.65 / $1,313.65	Professional		$1,313.65	$1,313.65	$1,313.65
Medica Facility/Professional Facility Modifier Low / Median / High Price $2,543.63 / $3,660.81 / $17,132.59	Facility		$2,543.63	$3,660.81	$17,132.59
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,826.34 / $4,139.70 / $11,116.93	Professional		$1,826.34	$4,139.70	$11,116.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $65.00 / $65.00 / $90.00	Professional		$65.00	$65.00	$90.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $2,543.63 / $3,660.81 / $3,843.85	Facility		$2,543.63	$3,660.81	$3,843.85
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,313.65 / $1,313.65 / $1,313.65	Professional		$1,313.65	$1,313.65	$1,313.65
Quartz Facility/Professional Professional Modifier Low / Median / High Price $639.36 / $1,332.81 / $1,900.80	Professional		$639.36	$1,332.81	$1,900.80
Quartz Facility/Professional Facility Modifier Low / Median / High Price $65.00 / $7,431.44 / $17,132.59	Facility		$65.00	$7,431.44	$17,132.59
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,275.00 / $1,275.00 / $1,275.00	Professional		$1,275.00	$1,275.00	$1,275.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,660.81 / $3,660.81 / $3,660.81	Professional		$3,660.81	$3,660.81	$3,660.81
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,660.81 / $3,660.81 / $3,660.81	Professional		$3,660.81	$3,660.81	$3,660.81
United Facility/Professional Professional Modifier Low / Median / High Price $1,430.00 / $3,234.21 / $11,116.93	Professional		$1,430.00	$3,234.21	$11,116.93