Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,231.11 / $2,231.11 / $2,231.11	Facility		$2,231.11	$2,231.11	$2,231.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,852.39 / $2,231.11 / $3,737.97	Professional		$1,852.39	$2,231.11	$3,737.97
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,422.75 / $4,865.03 / $8,049.41	Facility		$4,422.75	$4,865.03	$8,049.41
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,980.47 / $4,113.16 / $5,439.98	Professional		$3,980.47	$4,113.16	$5,439.98
CareSource Facility/Professional Facility Modifier Low / Median / High Price $3,181.72 / $9,464.69 / $9,464.69	Facility		$3,181.72	$9,464.69	$9,464.69
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,060.59 / $9,143.49 / $18,460.25	Facility		$3,060.59	$9,143.49	$18,460.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,234.23 / $7,365.95 / $8,370.40	Professional		$2,234.23	$7,365.95	$8,370.40
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,272.51 / $3,346.67 / $5,086.16	Facility		$1,272.51	$3,346.67	$5,086.16
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $2,532.37 / $4,316.78 / $5,307.30	Professional		$2,532.37	$4,316.78	$5,307.30
Medica Facility/Professional Facility Modifier Low / Median / High Price $2,202.77 / $4,422.75 / $20,671.75	Facility		$2,202.77	$4,422.75	$20,671.75
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,992.25 / $2,955.17 / $4,815.83	Professional		$1,992.25	$2,955.17	$4,815.83
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 $1,272.51 / $3,346.67 / $5,086.16	Facility		$1,272.51	$3,346.67	$5,086.16
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $2,532.37 / $4,316.78 / $5,307.30	Professional		$2,532.37	$4,316.78	$5,307.30
Quartz Facility/Professional Professional Modifier Low / Median / High Price $4,422.75 / $6,806.48 / $11,826.60	Professional		$4,422.75	$6,806.48	$11,826.60
Quartz Facility/Professional Facility Modifier Low / Median / High Price $3,060.59 / $8,638.18 / $20,671.75	Facility		$3,060.59	$8,638.18	$20,671.75
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,234.23 / $3,060.59 / $22,266.87	Professional		$2,234.23	$3,060.59	$22,266.87
Security Health Facility/Professional Professional Modifier Low / Median / High Price $4,422.75 / $4,422.75 / $4,422.75	Professional		$4,422.75	$4,422.75	$4,422.75
Security Health Facility/Professional Professional Modifier Low / Median / High Price $4,422.75 / $4,422.75 / $4,422.75	Professional		$4,422.75	$4,422.75	$4,422.75
United Facility/Professional Professional Modifier Low / Median / High Price $1,761.97 / $2,604.69 / $3,921.28	Professional		$1,761.97	$2,604.69	$3,921.28