Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,686.40 / $5,087.78 / $5,843.07	Facility		$2,686.40	$5,087.78	$5,843.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,608.16 / $2,634.24 / $3,129.79	Professional		$2,608.16	$2,634.24	$3,129.79
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,260.20 / $4,825.10 / $5,816.20	Facility		$3,260.20	$4,825.10	$5,816.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,608.16 / $2,608.16 / $3,521.01	Professional		$2,608.16	$2,608.16	$3,521.01
CareSource Facility/Professional Facility Modifier Low / Median / High Price $4,173.06 / $4,694.68 / $4,780.51	Facility		$4,173.06	$4,694.68	$4,780.51
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,608.16 / $3,865.58 / $7,071.64	Facility		$2,608.16	$3,865.58	$7,071.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,608.16 / $3,321.71 / $4,463.33	Professional		$2,608.16	$3,321.71	$4,463.33
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,854.05 / $2,608.16 / $3,760.96	Facility		$1,854.05	$2,608.16	$3,760.96
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,304.02 / $5,216.32 / $5,216.32	Professional		$1,304.02	$5,216.32	$5,216.32
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,854.05 / $2,543.89 / $3,561.45	Facility		$1,854.05	$2,543.89	$3,561.45
Medica Facility/Professional Professional Modifier Low / Median / High Price $2,543.89 / $2,831.88 / $12,064.38	Professional		$2,543.89	$2,831.88	$12,064.38
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 $1,854.05 / $2,608.16 / $3,760.96	Facility		$1,854.05	$2,608.16	$3,760.96
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,304.02 / $5,216.32 / $5,216.32	Professional		$1,304.02	$5,216.32	$5,216.32
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,608.16 / $3,896.99 / $8,448.00	Professional		$2,608.16	$3,896.99	$8,448.00
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,608.16 / $2,608.16 / $13,367.15	Facility		$2,608.16	$2,608.16	$13,367.15
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,608.16 / $5,026.83 / $12,064.38	Professional		$2,608.16	$5,026.83	$12,064.38
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,521.67 / $3,661.86 / $3,842.49	Professional		$2,521.67	$3,661.86	$3,842.49
United Facility/Professional Facility Modifier Low / Median / High Price $2,673.43 / $2,673.43 / $5,747.87	Facility		$2,673.43	$2,673.43	$5,747.87
United Facility/Professional Professional Modifier Low / Median / High Price $2,608.16 / $2,738.57 / $3,286.28	Professional		$2,608.16	$2,738.57	$3,286.28