Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,778.99 / $5,396.10 / $6,197.15	Facility		$2,778.99	$5,396.10	$6,197.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,698.05 / $2,778.99 / $3,705.23	Professional		$2,698.05	$2,778.99	$3,705.23
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,372.56 / $4,991.39 / $6,016.65	Facility		$3,372.56	$4,991.39	$6,016.65
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,698.05 / $2,698.05 / $3,642.36	Professional		$2,698.05	$2,698.05	$3,642.36
CareSource Facility/Professional Facility Modifier Low / Median / High Price $4,316.88 / $4,856.49 / $4,945.27	Facility		$4,316.88	$4,856.49	$4,945.27
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,698.05 / $3,982.85 / $7,286.17	Facility		$2,698.05	$3,982.85	$7,286.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,698.05 / $3,385.36 / $5,066.10	Professional		$2,698.05	$3,385.36	$5,066.10
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $2,698.05 / $2,698.05 / $2,983.52	Facility		$2,698.05	$2,698.05	$2,983.52
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $4,047.08 / $5,396.10 / $5,396.10	Professional		$4,047.08	$5,396.10	$5,396.10
Medica Facility/Professional Facility Modifier Low / Median / High Price $2,698.05 / $2,698.05 / $2,997.53	Facility		$2,698.05	$2,698.05	$2,997.53
Medica Facility/Professional Professional Modifier Low / Median / High Price $2,698.05 / $3,003.50 / $11,735.90	Professional		$2,698.05	$3,003.50	$11,735.90
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 $2,698.05 / $2,698.05 / $2,983.52	Facility		$2,698.05	$2,698.05	$2,983.52
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $4,047.08 / $5,396.10 / $5,396.10	Professional		$4,047.08	$5,396.10	$5,396.10
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,698.05 / $3,532.10 / $9,039.79	Professional		$2,698.05	$3,532.10	$9,039.79
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,658.13 / $2,698.05 / $13,290.65	Facility		$2,658.13	$2,698.05	$13,290.65
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,698.05 / $4,889.96 / $11,735.90	Professional		$2,698.05	$4,889.96	$11,735.90
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,788.06 / $3,788.06 / $3,788.06	Professional		$3,788.06	$3,788.06	$3,788.06
United Facility/Professional Professional Modifier Low / Median / High Price $2,698.05 / $2,832.95 / $3,210.68	Professional		$2,698.05	$2,832.95	$3,210.68