Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,126.78 / $2,126.78 / $2,126.78	Facility		$2,126.78	$2,126.78	$2,126.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,621.58 / $2,126.78 / $3,531.26	Professional		$1,621.58	$2,126.78	$3,531.26
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,215.93 / $4,637.52 / $7,672.99	Facility		$4,215.93	$4,637.52	$7,672.99
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,920.81 / $3,920.81 / $5,185.59	Professional		$3,920.81	$3,920.81	$5,185.59
CareSource Facility/Professional Facility Modifier Low / Median / High Price $3,032.93 / $9,022.09 / $9,022.09	Facility		$3,032.93	$9,022.09	$9,022.09
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,970.85 / $8,715.70 / $17,598.12	Facility		$2,970.85	$8,715.70	$17,598.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,168.71 / $6,109.22 / $7,978.98	Professional		$2,168.71	$6,109.22	$7,978.98
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,192.80 / $3,190.17 / $4,848.32	Facility		$1,192.80	$3,190.17	$4,848.32
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $2,413.94 / $4,114.93 / $5,059.12	Professional		$2,413.94	$4,114.93	$5,059.12
Medica Facility/Professional Facility Modifier Low / Median / High Price $2,064.78 / $4,215.93 / $19,143.40	Facility		$2,064.78	$4,215.93	$19,143.40
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,899.08 / $2,783.19 / $4,619.06	Professional		$1,899.08	$2,783.19	$4,619.06
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 $1,192.80 / $3,190.17 / $4,848.32	Facility		$1,192.80	$3,190.17	$4,848.32
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $2,413.94 / $4,114.93 / $5,059.12	Professional		$2,413.94	$4,114.93	$5,059.12
Quartz Facility/Professional Professional Modifier Low / Median / High Price $4,215.93 / $6,488.17 / $11,085.87	Professional		$4,215.93	$6,488.17	$11,085.87
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,970.85 / $8,234.24 / $19,143.40	Facility		$2,970.85	$8,234.24	$19,143.40
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,168.71 / $2,970.85 / $24,162.56	Professional		$2,168.71	$2,970.85	$24,162.56
Security Health Facility/Professional Professional Modifier Low / Median / High Price $4,215.93 / $4,215.93 / $4,215.93	Professional		$4,215.93	$4,215.93	$4,215.93
Security Health Facility/Professional Professional Modifier Low / Median / High Price $4,215.93 / $4,215.93 / $4,215.93	Professional		$4,215.93	$4,215.93	$4,215.93
United Facility/Professional Professional Modifier Low / Median / High Price $1,539.69 / $2,463.50 / $4,215.93	Professional		$1,539.69	$2,463.50	$4,215.93