Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,802.91 / $3,802.91 / $3,802.91	Facility		$3,802.91	$3,802.91	$3,802.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $3,692.14 / $3,802.91 / $4,061.36	Professional		$3,692.14	$3,802.91	$4,061.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,692.14 / $3,692.14 / $5,907.42	Professional		$3,692.14	$3,692.14	$5,907.42
CareSource Facility/Professional Facility Modifier Low / Median / High Price $5,054.88 / $5,907.42 / $5,907.42	Facility		$5,054.88	$5,907.42	$5,907.42
Cigna Facility/Professional Facility Modifier Low / Median / High Price $4,000.54 / $7,318.54 / $10,372.91	Facility		$4,000.54	$7,318.54	$10,372.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $3,045.60 / $3,692.14 / $3,867.91	Professional		$3,045.60	$3,692.14	$3,867.91
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $3,692.14 / $3,802.91 / $5,818.45	Facility		$3,692.14	$3,802.91	$5,818.45
Medica Facility/Professional Facility Modifier Low / Median / High Price $3,774.77 / $3,888.02 / $5,948.67	Facility		$3,774.77	$3,888.02	$5,948.67
Medica Facility/Professional Professional Modifier Low / Median / High Price $3,774.77 / $3,774.77 / $7,927.02	Professional		$3,774.77	$3,774.77	$7,927.02
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 $3,692.14 / $3,802.91 / $5,818.45	Facility		$3,692.14	$3,802.91	$5,818.45
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,692.14 / $3,692.14 / $5,747.20	Professional		$3,692.14	$3,692.14	$5,747.20
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,929.02 / $3,896.15 / $12,825.00	Facility		$2,929.02	$3,896.15	$12,825.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,692.14 / $4,089.00 / $12,996.00	Professional		$3,692.14	$4,089.00	$12,996.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $5,183.76 / $5,183.76 / $5,183.76	Professional		$5,183.76	$5,183.76	$5,183.76
United Facility/Professional Professional Modifier Low / Median / High Price $3,692.14 / $3,692.14 / $4,430.57	Professional		$3,692.14	$3,692.14	$4,430.57