Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $5,670.45 / $14,836.46 / $40,815.86	Facility		$5,670.45	$14,836.46	$40,815.86
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $44,428.46 / $44,428.46 / $44,428.46	Facility	50	$44,428.46	$44,428.46	$44,428.46
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $922.82 / $922.82 / $3,459.29	Facility	54	$922.82	$922.82	$3,459.29
Aetna Facility/Professional Facility Modifier AS Low / Median / High Price $5,272.85 / $5,272.85 / $5,272.85	Facility	AS	$5,272.85	$5,272.85	$5,272.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $828.51 / $1,845.64 / $9,774.93	Professional		$828.51	$1,845.64	$9,774.93
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $159.55 / $764.59 / $2,754.00	Professional	AS	$159.55	$764.59	$2,754.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $12,080.00 / $17,505.00 / $23,937.00	Facility		$12,080.00	$17,505.00	$23,937.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,291.02 / $2,839.45 / $7,598.49	Professional		$1,291.02	$2,839.45	$7,598.49
Anthem BCBS Facility/Professional Professional Modifier AS Low / Median / High Price $180.74 / $397.52 / $1,063.78	Professional	AS	$180.74	$397.52	$1,063.78
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,217.83 / $1,527.16 / $20,478.49	Facility		$1,217.83	$1,527.16	$20,478.49
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,150.22 / $1,210.36 / $1,659.78	Professional		$1,150.22	$1,210.36	$1,659.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,255.75 / $3,804.60 / $5,836.35	Facility		$3,255.75	$3,804.60	$5,836.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,925.62 / $5,015.18 / $5,699.06	Professional		$1,925.62	$5,015.18	$5,699.06
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,230.43 / $1,845.65 / $3,199.12	Facility		$1,230.43	$1,845.65	$3,199.12
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,317.66 / $6,412.22 / $19,562.00	Facility		$1,317.66	$6,412.22	$19,562.00
Medica Facility/Professional Facility Modifier 50 Low / Median / High Price $10,658.26 / $10,658.26 / $10,658.26	Facility	50	$10,658.26	$10,658.26	$10,658.26
Medica Facility/Professional Facility Modifier AS Low / Median / High Price $5,679.00 / $5,679.00 / $5,679.00	Facility	AS	$5,679.00	$5,679.00	$5,679.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,537.31 / $2,850.48 / $11,316.67	Professional		$1,537.31	$2,850.48	$11,316.67
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 $1,230.43 / $1,845.65 / $3,199.12	Facility		$1,230.43	$1,845.65	$3,199.12
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,527.19 / $3,079.30 / $4,596.78	Professional		$2,527.19	$3,079.30	$4,596.78
Quartz Facility/Professional Facility Modifier Low / Median / High Price $19,017.90 / $19,017.90 / $52,497.75	Facility		$19,017.90	$19,017.90	$52,497.75
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $34,832.28 / $34,832.28 / $34,832.28	Facility	54	$34,832.28	$34,832.28	$34,832.28
Quartz Facility/Professional Facility Modifier AS Low / Median / High Price $4,976.04 / $4,976.04 / $4,976.04	Facility	AS	$4,976.04	$4,976.04	$4,976.04
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,346.37 / $6,433.90 / $11,316.67	Professional		$2,346.37	$6,433.90	$11,316.67
Security Health Facility/Professional Professional Modifier Low / Median / High Price $4,365.58 / $6,758.44 / $10,383.48	Professional		$4,365.58	$6,758.44	$10,383.48
United Facility/Professional Facility Modifier Low / Median / High Price $8,650.00 / $14,566.00 / $27,414.00	Facility		$8,650.00	$14,566.00	$27,414.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,502.16 / $2,824.87 / $5,854.85	Professional		$1,502.16	$2,824.87	$5,854.85