Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,123.20 / $1,404.00 / $2,087.28	Facility		$1,123.20	$1,404.00	$2,087.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $748.80 / $879.84 / $1,123.20	Professional		$748.80	$879.84	$1,123.20
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,012.40 / $2,433.60 / $2,574.00	Facility		$2,012.40	$2,433.60	$2,574.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $374.40 / $645.84 / $4,009.08	Professional		$374.40	$645.84	$4,009.08
CareSource Facility/Professional Facility Modifier Low / Median / High Price $704.34 / $2,287.48 / $2,377.44	Facility		$704.34	$2,287.48	$2,377.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,576.30 / $3,010.61 / $4,618.35	Facility		$2,576.30	$3,010.61	$4,618.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,075.86 / $2,520.46 / $2,864.16	Professional		$1,075.86	$2,520.46	$2,864.16
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $561.60 / $936.00 / $1,840.22	Facility		$561.60	$936.00	$1,840.22
Medica Facility/Professional Facility Modifier Low / Median / High Price $561.60 / $1,123.20 / $4,446.00	Facility		$561.60	$1,123.20	$4,446.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $468.00 / $748.80 / $2,592.71	Professional		$468.00	$748.80	$2,592.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $55.00 / $85.00 / $2,583.36	Professional		$55.00	$85.00	$2,583.36
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $561.60 / $936.00 / $1,840.22	Facility		$561.60	$936.00	$1,840.22
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,562.76 / $2,232.14 / $3,130.73	Professional		$1,562.76	$2,232.14	$3,130.73
Quartz Facility/Professional Facility Modifier Low / Median / High Price $496.08 / $1,872.00 / $4,446.00	Facility		$496.08	$1,872.00	$4,446.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $496.08 / $4,680.00 / $4,680.00	Professional		$496.08	$4,680.00	$4,680.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,993.25 / $1,993.25 / $1,993.25	Professional		$1,993.25	$1,993.25	$1,993.25
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,720.22 / $5,110.56 / $5,110.56	Professional		$2,720.22	$5,110.56	$5,110.56
United Facility/Professional Professional Modifier Low / Median / High Price $468.00 / $561.60 / $1,965.60	Professional		$468.00	$561.60	$1,965.60