Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,535.21 / $2,535.21 / $2,535.21	Facility		$2,535.21	$2,535.21	$2,535.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,052.38 / $2,535.21 / $4,209.39	Professional		$2,052.38	$2,535.21	$4,209.39
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $5,025.57 / $5,528.13 / $9,146.54	Facility		$5,025.57	$5,528.13	$9,146.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $4,506.22 / $4,673.78 / $6,181.45	Professional		$4,506.22	$4,673.78	$6,181.45
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,446.15 / $4,301.85 / $10,754.72	Facility		$1,446.15	$4,301.85	$10,754.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,802.84 / $10,390.19 / $20,976.67	Facility		$2,802.84	$10,390.19	$20,976.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,382.41 / $7,399.02 / $9,511.28	Professional		$2,382.41	$7,399.02	$9,511.28
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,444.68 / $3,802.82 / $5,779.41	Facility		$1,444.68	$3,802.82	$5,779.41
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $2,877.52 / $5,025.57 / $6,030.68	Professional		$2,877.52	$5,025.57	$6,030.68
Medica Facility/Professional Facility Modifier Low / Median / High Price $2,500.81 / $5,025.57 / $23,456.39	Facility		$2,500.81	$5,025.57	$23,456.39
Medica Facility/Professional Professional Modifier Low / Median / High Price $2,263.78 / $3,357.95 / $5,472.22	Professional		$2,263.78	$3,357.95	$5,472.22
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $85.00 / $3,203.38	Professional		$50.00	$85.00	$3,203.38
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,444.68 / $3,802.82 / $5,779.41	Facility		$1,444.68	$3,802.82	$5,779.41
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $2,877.52 / $5,025.57 / $6,030.68	Professional		$2,877.52	$5,025.57	$6,030.68
Quartz Facility/Professional Professional Modifier Low / Median / High Price $5,025.57 / $7,734.19 / $13,427.50	Professional		$5,025.57	$7,734.19	$13,427.50
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,802.84 / $9,815.56 / $23,456.39	Facility		$2,802.84	$9,815.56	$23,456.39
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,382.41 / $2,802.84 / $26,401.10	Professional		$2,382.41	$2,802.84	$26,401.10
Security Health Facility/Professional Professional Modifier Low / Median / High Price $5,025.57 / $5,025.57 / $5,025.57	Professional		$5,025.57	$5,025.57	$5,025.57
Security Health Facility/Professional Professional Modifier Low / Median / High Price $5,025.57 / $5,025.57 / $5,025.57	Professional		$5,025.57	$5,025.57	$5,025.57
United Facility/Professional Professional Modifier Low / Median / High Price $1,864.83 / $3,015.34 / $5,472.22	Professional		$1,864.83	$3,015.34	$5,472.22