Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,920.76 / $1,920.76 / $1,920.76	Facility		$1,920.76	$1,920.76	$1,920.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,594.72 / $1,920.76 / $3,218.01	Professional		$1,594.72	$1,920.76	$3,218.01
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,807.55 / $4,188.31 / $6,929.74	Facility		$3,807.55	$4,188.31	$6,929.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,426.79 / $3,541.02 / $4,683.28	Professional		$3,426.79	$3,541.02	$4,683.28
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,739.14 / $8,148.16 / $8,148.16	Facility		$2,739.14	$8,148.16	$8,148.16
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,463.07 / $8,406.40 / $15,893.45	Facility		$2,463.07	$8,406.40	$15,893.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,798.04 / $5,517.66 / $7,206.09	Professional		$1,798.04	$5,517.66	$7,206.09
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,095.49 / $2,881.14 / $4,378.68	Facility		$1,095.49	$2,881.14	$4,378.68
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $2,180.11 / $3,716.28 / $4,569.06	Professional		$2,180.11	$3,716.28	$4,569.06
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,896.34 / $3,807.55 / $17,730.55	Facility		$1,896.34	$3,807.55	$17,730.55
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,738.62 / $2,544.10 / $4,145.95	Professional		$1,738.62	$2,544.10	$4,145.95
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $2,569.54	Professional		$50.00	$70.00	$2,569.54
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,095.49 / $2,881.14 / $4,378.68	Facility		$1,095.49	$2,881.14	$4,378.68
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $2,180.11 / $3,716.28 / $4,569.06	Professional		$2,180.11	$3,716.28	$4,569.06
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,807.55 / $5,859.70 / $10,181.53	Professional		$3,807.55	$5,859.70	$10,181.53
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,463.07 / $7,436.62 / $17,730.55	Facility		$2,463.07	$7,436.62	$17,730.55
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,798.04 / $2,463.07 / $19,169.56	Professional		$1,798.04	$2,463.07	$19,169.56
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,807.55 / $3,807.55 / $3,807.55	Professional		$3,807.55	$3,807.55	$3,807.55
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,807.55 / $3,807.55 / $3,807.55	Professional		$3,807.55	$3,807.55	$3,807.55
United Facility/Professional Professional Modifier Low / Median / High Price $1,516.88 / $2,284.53 / $3,807.55	Professional		$1,516.88	$2,284.53	$3,807.55