Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,213.69 / $2,213.69 / $2,213.69	Facility		$2,213.69	$2,213.69	$2,213.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,828.86 / $2,213.69 / $3,690.48	Professional		$1,828.86	$2,213.69	$3,690.48
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,388.25 / $4,827.08 / $7,986.62	Facility		$4,388.25	$4,827.08	$7,986.62
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,795.39 / $4,081.07 / $5,397.54	Professional		$3,795.39	$4,081.07	$5,397.54
CareSource Facility/Professional Facility Modifier Low / Median / High Price $3,156.89 / $9,390.86 / $9,390.86	Facility		$3,156.89	$9,390.86	$9,390.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,728.17 / $9,072.16 / $18,317.49	Facility		$2,728.17	$9,072.16	$18,317.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,991.56 / $7,308.49 / $8,305.10	Professional		$1,991.56	$7,308.49	$8,305.10
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,277.01 / $3,320.55 / $5,046.49	Facility		$1,277.01	$3,320.55	$5,046.49
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $2,512.59 / $4,388.25 / $5,265.90	Professional		$2,512.59	$4,388.25	$5,265.90
Medica Facility/Professional Facility Modifier Low / Median / High Price $2,210.56 / $4,388.25 / $20,802.65	Facility		$2,210.56	$4,388.25	$20,802.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,978.08 / $2,932.09 / $4,816.75	Professional		$1,978.08	$2,932.09	$4,816.75
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $2,675.77	Professional		$50.00	$70.00	$2,675.77
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,277.01 / $3,320.55 / $5,046.49	Facility		$1,277.01	$3,320.55	$5,046.49
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $2,512.59 / $4,388.25 / $5,265.90	Professional		$2,512.59	$4,388.25	$5,265.90
Quartz Facility/Professional Professional Modifier Low / Median / High Price $4,388.25 / $6,753.34 / $11,868.75	Professional		$4,388.25	$6,753.34	$11,868.75
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,728.17 / $8,570.79 / $20,802.65	Facility		$2,728.17	$8,570.79	$20,802.65
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,991.56 / $2,728.17 / $24,201.14	Professional		$1,991.56	$2,728.17	$24,201.14
Security Health Facility/Professional Professional Modifier Low / Median / High Price $4,388.25 / $4,388.25 / $4,388.25	Professional		$4,388.25	$4,388.25	$4,388.25
Security Health Facility/Professional Professional Modifier Low / Median / High Price $4,388.25 / $4,388.25 / $4,388.25	Professional		$4,388.25	$4,388.25	$4,388.25
United Facility/Professional Professional Modifier Low / Median / High Price $1,548.82 / $2,637.44 / $3,890.69	Professional		$1,548.82	$2,637.44	$3,890.69