Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,901.83 / $1,901.83 / $1,901.83	Facility		$1,901.83	$1,901.83	$1,901.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,578.98 / $1,901.83 / $3,186.26	Professional		$1,578.98	$1,901.83	$3,186.26
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,770.02 / $4,147.02 / $6,861.44	Facility		$3,770.02	$4,147.02	$6,861.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,393.01 / $3,506.12 / $4,637.12	Professional		$3,393.01	$3,506.12	$4,637.12
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,712.14 / $8,067.84 / $8,067.84	Facility		$2,712.14	$8,067.84	$8,067.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,677.88 / $7,794.52 / $15,736.70	Facility		$2,677.88	$7,794.52	$15,736.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,954.85 / $5,463.28 / $7,135.06	Professional		$1,954.85	$5,463.28	$7,135.06
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,091.50 / $2,852.75 / $4,335.52	Facility		$1,091.50	$2,852.75	$4,335.52
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $2,158.62 / $3,679.64 / $4,524.02	Professional		$2,158.62	$3,679.64	$4,524.02
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,889.43 / $3,770.02 / $17,719.04	Facility		$1,889.43	$3,770.02	$17,719.04
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,713.43 / $2,519.02 / $4,126.67	Professional		$1,713.43	$2,519.02	$4,126.67
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $2,430.59	Professional		$50.00	$70.00	$2,430.59
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,091.50 / $2,852.75 / $4,335.52	Facility		$1,091.50	$2,852.75	$4,335.52
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $2,158.62 / $3,679.64 / $4,524.02	Professional		$2,158.62	$3,679.64	$4,524.02
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,770.02 / $5,801.93 / $10,144.40	Professional		$3,770.02	$5,801.93	$10,144.40
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,677.88 / $7,363.32 / $17,719.04	Facility		$2,677.88	$7,363.32	$17,719.04
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,954.85 / $2,677.88 / $18,980.66	Professional		$1,954.85	$2,677.88	$18,980.66
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,770.02 / $3,770.02 / $3,770.02	Professional		$3,770.02	$3,770.02	$3,770.02
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,770.02 / $3,770.02 / $3,770.02	Professional		$3,770.02	$3,770.02	$3,770.02
United Facility/Professional Professional Modifier Low / Median / High Price $1,408.94 / $2,507.76 / $4,105.08	Professional		$1,408.94	$2,507.76	$4,105.08