Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $720.00 / $720.00 / $720.00	Facility		$720.00	$720.00	$720.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $462.00 / $564.00 / $720.00	Professional		$462.00	$564.00	$720.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $240.00 / $240.00 / $2,482.51	Professional		$240.00	$240.00	$2,482.51
CareSource Facility/Professional Facility Modifier Low / Median / High Price $913.03 / $913.03 / $913.03	Facility		$913.03	$913.03	$913.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,650.85 / $1,929.15 / $2,959.37	Facility		$1,650.85	$1,929.15	$2,959.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $710.40 / $1,615.68 / $1,836.00	Professional		$710.40	$1,615.68	$1,836.00
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $462.00 / $720.00 / $2,100.00	Facility		$462.00	$720.00	$2,100.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $462.00 / $720.00 / $2,100.00	Facility		$462.00	$720.00	$2,100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $300.00 / $360.00 / $1,850.31	Professional		$300.00	$360.00	$1,850.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $85.00	Professional		$50.00	$70.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $462.00 / $720.00 / $2,100.00	Facility		$462.00	$720.00	$2,100.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,001.70 / $1,430.76 / $2,006.74	Professional		$1,001.70	$1,430.76	$2,006.74
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,200.00 / $2,850.00 / $2,850.00	Facility		$1,200.00	$2,850.00	$2,850.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,400.00 / $2,400.00 / $2,988.00	Professional		$2,400.00	$2,400.00	$2,988.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,277.73 / $1,277.73 / $1,277.73	Professional		$1,277.73	$1,277.73	$1,277.73
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,276.00 / $3,276.00 / $3,276.00	Professional		$3,276.00	$3,276.00	$3,276.00
United Facility/Professional Professional Modifier Low / Median / High Price $252.00 / $360.00 / $1,260.00	Professional		$252.00	$360.00	$1,260.00