Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,434.91 / $1,434.91 / $1,434.91	Facility		$1,434.91	$1,434.91	$1,434.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,393.12 / $1,434.91 / $1,532.43	Professional		$1,393.12	$1,434.91	$1,532.43
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,393.12 / $1,393.12 / $2,368.30	Professional		$1,393.12	$1,393.12	$2,368.30
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,907.31 / $2,061.82 / $2,228.98	Facility		$1,907.31	$2,061.82	$2,228.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,766.33 / $5,060.68 / $7,172.76	Facility		$2,766.33	$5,060.68	$7,172.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,393.12 / $1,471.39 / $2,632.50	Professional		$1,393.12	$1,471.39	$2,632.50
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,393.12 / $1,462.78 / $2,195.41	Facility		$1,393.12	$1,462.78	$2,195.41
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,713.18 / $1,764.58 / $2,699.81	Facility		$1,713.18	$1,764.58	$2,699.81
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,713.18 / $1,713.18 / $3,597.68	Professional		$1,713.18	$1,713.18	$3,597.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $58.40 / $85.00	Professional		$50.00	$58.40	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,393.12 / $1,462.78 / $2,195.41	Facility		$1,393.12	$1,462.78	$2,195.41
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,393.12 / $1,393.12 / $2,492.82	Professional		$1,393.12	$1,393.12	$2,492.82
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,608.27 / $2,340.00 / $8,775.00	Facility		$1,608.27	$2,340.00	$8,775.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,393.12 / $2,827.50 / $8,892.00	Professional		$1,393.12	$2,827.50	$8,892.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,955.94 / $1,955.94 / $1,955.94	Professional		$1,955.94	$1,955.94	$1,955.94
United Facility/Professional Professional Modifier Low / Median / High Price $1,393.12 / $1,393.12 / $1,811.06	Professional		$1,393.12	$1,393.12	$1,811.06