Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,275.78 / $2,275.78 / $2,275.78	Facility		$2,275.78	$2,275.78	$2,275.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,755.45 / $2,275.78 / $3,778.66	Professional		$1,755.45	$2,275.78	$3,778.66
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,511.30 / $4,962.43 / $8,210.57	Facility		$4,511.30	$4,962.43	$8,210.57
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $4,195.51 / $4,195.51 / $5,548.89	Professional		$4,195.51	$4,195.51	$5,548.89
CareSource Facility/Professional Facility Modifier Low / Median / High Price $3,245.43 / $9,654.18 / $9,654.18	Facility		$3,245.43	$9,654.18	$9,654.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,741.63 / $9,960.23 / $18,831.13	Facility		$2,741.63	$9,960.23	$18,831.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,001.39 / $6,642.26 / $8,538.00	Professional		$2,001.39	$6,642.26	$8,538.00
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,357.23 / $3,413.67 / $5,188.00	Facility		$1,357.23	$3,413.67	$5,188.00
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $2,583.06 / $4,214.02 / $5,413.56	Professional		$2,583.06	$4,214.02	$5,413.56
Medica Facility/Professional Facility Modifier Low / Median / High Price $2,275.78 / $4,511.30 / $21,030.00	Facility		$2,275.78	$4,511.30	$21,030.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $2,097.55 / $3,143.94 / $4,912.26	Professional		$2,097.55	$3,143.94	$4,912.26
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $65.00 / $85.00	Professional		$50.00	$65.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,357.23 / $3,413.67 / $5,188.00	Facility		$1,357.23	$3,413.67	$5,188.00
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $2,583.06 / $4,214.02 / $5,413.56	Professional		$2,583.06	$4,214.02	$5,413.56
Quartz Facility/Professional Professional Modifier Low / Median / High Price $4,511.30 / $6,942.77 / $12,614.50	Professional		$4,511.30	$6,942.77	$12,614.50
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,741.63 / $8,811.14 / $21,030.00	Facility		$2,741.63	$8,811.14	$21,030.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,001.39 / $2,741.63 / $27,812.52	Professional		$2,001.39	$2,741.63	$27,812.52
Security Health Facility/Professional Professional Modifier Low / Median / High Price $4,511.30 / $4,511.30 / $4,511.30	Professional		$4,511.30	$4,511.30	$4,511.30
Security Health Facility/Professional Professional Modifier Low / Median / High Price $4,511.30 / $4,511.30 / $4,511.30	Professional		$4,511.30	$4,511.30	$4,511.30
United Facility/Professional Professional Modifier Low / Median / High Price $1,646.10 / $2,712.22 / $3,999.80	Professional		$1,646.10	$2,712.22	$3,999.80