Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,165.80 / $2,165.80 / $2,165.80	Facility		$2,165.80	$2,165.80	$2,165.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,549.96 / $2,165.80 / $3,596.05	Professional		$1,549.96	$2,165.80	$3,596.05
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,293.29 / $4,722.62 / $7,813.79	Facility		$4,293.29	$4,722.62	$7,813.79
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,992.76 / $3,992.76 / $5,280.74	Professional		$3,992.76	$3,992.76	$5,280.74
CareSource Facility/Professional Facility Modifier Low / Median / High Price $3,088.59 / $9,187.64 / $9,187.64	Facility		$3,088.59	$9,187.64	$9,187.64
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,717.61 / $8,876.12 / $17,920.02	Facility		$2,717.61	$8,876.12	$17,920.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,983.86 / $6,221.72 / $8,125.40	Professional		$1,983.86	$6,221.72	$8,125.40
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,191.82 / $3,248.70 / $4,937.28	Facility		$1,191.82	$3,248.70	$4,937.28
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $2,458.25 / $4,293.29 / $5,151.95	Professional		$2,458.25	$4,293.29	$5,151.95
Medica Facility/Professional Facility Modifier Low / Median / High Price $2,063.09 / $4,293.29 / $19,464.45	Facility		$2,063.09	$4,293.29	$19,464.45
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,933.93 / $2,780.91 / $4,674.85	Professional		$1,933.93	$2,780.91	$4,674.85
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $2,267.08	Professional		$50.00	$70.00	$2,267.08
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,191.82 / $3,262.35 / $4,937.28	Facility		$1,191.82	$3,262.35	$4,937.28
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $2,458.25 / $4,293.29 / $5,151.95	Professional		$2,458.25	$4,293.29	$5,151.95
Quartz Facility/Professional Professional Modifier Low / Median / High Price $4,293.29 / $6,607.24 / $11,076.83	Professional		$4,293.29	$6,607.24	$11,076.83
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,717.61 / $8,385.34 / $19,464.45	Facility		$2,717.61	$8,385.34	$19,464.45
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,983.86 / $2,717.61 / $24,570.97	Professional		$1,983.86	$2,717.61	$24,570.97
Security Health Facility/Professional Professional Modifier Low / Median / High Price $4,293.29 / $4,293.29 / $4,293.29	Professional		$4,293.29	$4,293.29	$4,293.29
Security Health Facility/Professional Professional Modifier Low / Median / High Price $4,293.29 / $4,293.29 / $4,293.29	Professional		$4,293.29	$4,293.29	$4,293.29
United Facility/Professional Professional Modifier Low / Median / High Price $1,615.97 / $2,575.96 / $4,156.57	Professional		$1,615.97	$2,575.96	$4,156.57