Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,790.28 / $2,790.28 / $2,790.28	Facility		$2,790.28	$2,790.28	$2,790.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,123.39 / $2,790.28 / $4,632.92	Professional		$2,123.39	$2,790.28	$4,632.92
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $5,531.20 / $6,084.32 / $10,066.78	Facility		$5,531.20	$6,084.32	$10,066.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $4,978.08 / $5,144.02 / $6,803.37	Professional		$4,978.08	$5,144.02	$6,803.37
CareSource Facility/Professional Facility Modifier Low / Median / High Price $3,979.14 / $11,836.77 / $11,836.77	Facility		$3,979.14	$11,836.77	$11,836.77
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,578.08 / $11,435.22 / $23,087.21	Facility		$3,578.08	$11,435.22	$23,087.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,612.00 / $9,212.04 / $10,468.23	Professional		$2,612.00	$9,212.04	$10,468.23
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,556.51 / $4,185.42 / $6,360.88	Facility		$1,556.51	$4,185.42	$6,360.88
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $3,167.03 / $5,531.20 / $6,637.44	Professional		$3,167.03	$5,531.20	$6,637.44
Medica Facility/Professional Facility Modifier Low / Median / High Price $2,694.38 / $5,531.20 / $25,854.57	Facility		$2,694.38	$5,531.20	$25,854.57
Medica Facility/Professional Professional Modifier Low / Median / High Price $2,443.40 / $3,631.86 / $6,027.54	Professional		$2,443.40	$3,631.86	$6,027.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $3,261.42	Professional		$50.00	$70.00	$3,261.42
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,556.51 / $4,185.42 / $6,360.88	Facility		$1,556.51	$4,185.42	$6,360.88
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $3,167.03 / $5,531.20 / $6,637.44	Professional		$3,167.03	$5,531.20	$6,637.44
Quartz Facility/Professional Professional Modifier Low / Median / High Price $5,531.20 / $8,512.32 / $14,466.33	Professional		$5,531.20	$8,512.32	$14,466.33
Quartz Facility/Professional Facility Modifier Low / Median / High Price $3,578.08 / $10,803.12 / $25,854.57	Facility		$3,578.08	$10,803.12	$25,854.57
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,612.00 / $3,578.08 / $45,109.85	Professional		$2,612.00	$3,578.08	$45,109.85
Security Health Facility/Professional Professional Modifier Low / Median / High Price $5,531.20 / $5,531.20 / $5,531.20	Professional		$5,531.20	$5,531.20	$5,531.20
Security Health Facility/Professional Professional Modifier Low / Median / High Price $5,531.20 / $5,531.20 / $5,531.20	Professional		$5,531.20	$5,531.20	$5,531.20
United Facility/Professional Professional Modifier Low / Median / High Price $2,179.12 / $3,628.23 / $5,531.20	Professional		$2,179.12	$3,628.23	$5,531.20