Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,754.62 / $2,754.62 / $2,754.62	Facility		$2,754.62	$2,754.62	$2,754.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,949.16 / $2,754.62 / $4,573.70	Professional		$1,949.16	$2,754.62	$4,573.70
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $5,460.50 / $6,006.55 / $9,938.11	Facility		$5,460.50	$6,006.55	$9,938.11
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $4,914.45 / $5,078.27 / $6,716.41	Professional		$4,914.45	$5,078.27	$6,716.41
CareSource Facility/Professional Facility Modifier Low / Median / High Price $3,928.28 / $11,685.47 / $11,685.47	Facility		$3,928.28	$11,685.47	$11,685.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,532.34 / $11,288.86 / $22,791.90	Facility		$3,532.34	$11,288.86	$22,791.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,578.61 / $7,912.97 / $10,334.43	Professional		$2,578.61	$7,912.97	$10,334.43
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,474.07 / $4,131.93 / $6,279.58	Facility		$1,474.07	$4,131.93	$6,279.58
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $3,126.55 / $5,460.50 / $6,552.60	Professional		$3,126.55	$5,460.50	$6,552.60
Medica Facility/Professional Facility Modifier Low / Median / High Price $2,551.69 / $5,460.50 / $24,019.87	Facility		$2,551.69	$5,460.50	$24,019.87
Medica Facility/Professional Professional Modifier Low / Median / High Price $2,455.44 / $3,439.51 / $5,945.81	Professional		$2,455.44	$3,439.51	$5,945.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $2,646.67	Professional		$50.00	$70.00	$2,646.67
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,474.07 / $4,131.93 / $6,279.58	Facility		$1,474.07	$4,131.93	$6,279.58
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $3,126.55 / $5,460.50 / $6,552.60	Professional		$3,126.55	$5,460.50	$6,552.60
Quartz Facility/Professional Professional Modifier Low / Median / High Price $5,460.50 / $8,403.51 / $13,700.51	Professional		$5,460.50	$8,403.51	$13,700.51
Quartz Facility/Professional Facility Modifier Low / Median / High Price $3,532.34 / $10,665.04 / $24,019.87	Facility		$3,532.34	$10,665.04	$24,019.87
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,578.61 / $3,532.34 / $30,222.77	Professional		$2,578.61	$3,532.34	$30,222.77
Security Health Facility/Professional Professional Modifier Low / Median / High Price $5,460.50 / $5,460.50 / $5,460.50	Professional		$5,460.50	$5,460.50	$5,460.50
Security Health Facility/Professional Professional Modifier Low / Median / High Price $5,460.50 / $5,460.50 / $5,460.50	Professional		$5,460.50	$5,460.50	$5,460.50
United Facility/Professional Facility Modifier Low / Median / High Price $3,050.06 / $3,050.06 / $3,050.06	Facility		$3,050.06	$3,050.06	$3,050.06
United Facility/Professional Professional Modifier Low / Median / High Price $1,816.12 / $3,276.30 / $5,286.57	Professional		$1,816.12	$3,276.30	$5,286.57