Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $4,617.80 / $15,962.80 / $45,636.50	Facility		$4,617.80	$15,962.80	$45,636.50
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $11,353.25 / $11,353.25 / $11,353.25	Facility	22	$11,353.25	$11,353.25	$11,353.25
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $923.66 / $923.66 / $3,463.35	Facility	54	$923.66	$923.66	$3,463.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,186.05 / $3,156.00 / $21,006.80	Professional		$1,186.05	$3,156.00	$21,006.80
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $128.93 / $835.39 / $2,816.90	Professional	AS	$128.93	$835.39	$2,816.90
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $11,499.00 / $15,502.00 / $22,428.00	Facility		$11,499.00	$15,502.00	$22,428.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,291.71 / $2,842.02 / $7,605.39	Professional		$1,291.71	$2,842.02	$7,605.39
Anthem BCBS Facility/Professional Professional Modifier AS Low / Median / High Price $180.83 / $397.88 / $1,064.75	Professional	AS	$180.83	$397.88	$1,064.75
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,219.34 / $1,529.14 / $20,478.49	Facility		$1,219.34	$1,529.14	$20,478.49
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,151.57 / $1,211.78 / $1,661.79	Professional		$1,151.57	$1,211.78	$1,661.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,261.15 / $3,810.92 / $6,146.87	Facility		$3,261.15	$3,810.92	$6,146.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,928.26 / $5,021.54 / $5,706.30	Professional		$1,928.26	$5,021.54	$5,706.30
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,231.54 / $1,847.31 / $3,202.00	Facility		$1,231.54	$1,847.31	$3,202.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,319.21 / $4,926.16 / $21,381.01	Facility		$1,319.21	$4,926.16	$21,381.01
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,537.64 / $2,827.63 / $13,550.61	Professional		$1,537.64	$2,827.63	$13,550.61
Molina Facility/Professional Professional Modifier Low / Median / High Price $126.60 / $766.43 / $2,409.58	Professional		$126.60	$766.43	$2,409.58
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,231.54 / $1,847.31 / $3,202.00	Facility		$1,231.54	$1,847.31	$3,202.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,530.44 / $3,083.26 / $4,602.68	Professional		$2,530.44	$3,083.26	$4,602.68
Quartz Facility/Professional Facility Modifier Low / Median / High Price $19,415.37 / $40,016.00 / $53,594.95	Facility		$19,415.37	$40,016.00	$53,594.95
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $35,560.28 / $35,560.28 / $35,560.28	Facility	54	$35,560.28	$35,560.28	$35,560.28
Quartz Facility/Professional Facility Modifier 62 Low / Median / High Price $31,750.25 / $31,750.25 / $31,750.25	Facility	62	$31,750.25	$31,750.25	$31,750.25
Quartz Facility/Professional Facility Modifier AS Low / Median / High Price $5,080.04 / $5,080.04 / $5,080.04	Facility	AS	$5,080.04	$5,080.04	$5,080.04
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,349.36 / $6,440.20 / $13,550.61	Professional		$2,349.36	$6,440.20	$13,550.61
Security Health Facility/Professional Professional Modifier Low / Median / High Price $4,361.99 / $6,286.88 / $9,475.95	Professional		$4,361.99	$6,286.88	$9,475.95
United Facility/Professional Facility Modifier Low / Median / High Price $8,650.00 / $15,355.00 / $27,414.00	Facility		$8,650.00	$15,355.00	$27,414.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,489.97 / $2,702.69 / $6,180.40	Professional		$1,489.97	$2,702.69	$6,180.40