Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $721.93 / $2,690.22 / $6,461.00	Facility		$721.93	$2,690.22	$6,461.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $721.93 / $1,055.81 / $4,833.00	Professional		$721.93	$1,055.81	$4,833.00
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $98.52 / $624.02 / $1,501.10	Professional	AS	$98.52	$624.02	$1,501.10
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $5,060.00 / $7,344.00 / $10,517.23	Facility		$5,060.00	$7,344.00	$10,517.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,035.36 / $2,154.58 / $4,589.71	Professional		$1,035.36	$2,154.58	$4,589.71
Anthem BCBS Facility/Professional Professional Modifier AS Low / Median / High Price $144.94 / $323.54 / $656.40	Professional	AS	$144.94	$323.54	$656.40
CareSource Facility/Professional Facility Modifier Low / Median / High Price $785.66 / $788.47 / $1,104.39	Facility		$785.66	$788.47	$1,104.39
CareSource Facility/Professional Professional Modifier Low / Median / High Price $986.58 / $1,085.24 / $1,359.00	Professional		$986.58	$1,085.24	$1,359.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,848.44 / $3,328.63 / $5,106.20	Facility		$2,848.44	$3,328.63	$5,106.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $955.63 / $1,576.93 / $2,774.86	Professional		$955.63	$1,576.93	$2,774.86
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $844.66 / $1,303.16 / $2,959.74	Facility		$844.66	$1,303.16	$2,959.74
Medica Facility/Professional Facility Modifier Low / Median / High Price $911.32 / $2,341.32 / $10,843.00	Facility		$911.32	$2,341.32	$10,843.00
Medica Facility/Professional Facility Modifier AS Low / Median / High Price $397.38 / $397.38 / $397.38	Facility	AS	$397.38	$397.38	$397.38
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,049.52 / $1,948.22 / $6,420.24	Professional		$1,049.52	$1,948.22	$6,420.24
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.48 / $623.76 / $1,998.23	Professional		$93.48	$623.76	$1,998.23
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $844.66 / $1,303.16 / $2,959.74	Facility		$844.66	$1,303.16	$2,959.74
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,890.00 / $2,575.42 / $3,583.32	Professional		$1,890.00	$2,575.42	$3,583.32
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,663.67 / $2,223.48 / $6,085.56	Facility		$1,663.67	$2,223.48	$6,085.56
Quartz Facility/Professional Facility Modifier AS Low / Median / High Price $166.37 / $222.35 / $397.38	Facility	AS	$166.37	$222.35	$397.38
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,031.93 / $3,623.58 / $8,026.00	Professional		$1,031.93	$3,623.58	$8,026.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,908.83 / $3,665.84 / $4,614.30	Professional		$1,908.83	$3,665.84	$4,614.30
United Facility/Professional Facility Modifier Low / Median / High Price $6,241.00 / $9,837.00 / $12,062.00	Facility		$6,241.00	$9,837.00	$12,062.00
United Facility/Professional Professional Modifier Low / Median / High Price $963.82 / $1,606.65 / $4,093.98	Professional		$963.82	$1,606.65	$4,093.98