Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,883.58 / $3,629.20 / $4,274.84	Facility		$1,883.58	$3,629.20	$4,274.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,828.72 / $1,883.58 / $7,974.62	Professional		$1,828.72	$1,883.58	$7,974.62
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,285.90 / $3,383.11 / $4,078.02	Facility		$2,285.90	$3,383.11	$4,078.02
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,828.72 / $1,828.72 / $2,322.46	Professional		$1,828.72	$1,828.72	$2,322.46
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,503.69 / $2,503.69 / $2,925.95	Facility		$2,503.69	$2,503.69	$2,925.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,828.71 / $4,278.35 / $6,115.62	Facility		$1,828.71	$4,278.35	$6,115.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,828.71 / $3,041.06 / $3,455.75	Professional		$1,828.71	$3,041.06	$3,455.75
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,828.72 / $1,861.13 / $4,030.37	Facility		$1,828.72	$1,861.13	$4,030.37
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $2,791.70 / $3,657.44 / $3,657.44	Professional		$2,791.70	$3,657.44	$3,657.44
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,861.13 / $1,861.13 / $4,101.66	Facility		$1,861.13	$1,861.13	$4,101.66
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,861.13 / $1,861.13 / $3,657.44	Professional		$1,861.13	$1,861.13	$3,657.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $65.00 / $85.00 / $1,755.81	Professional		$65.00	$85.00	$1,755.81
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,828.72 / $1,861.13 / $4,030.37	Facility		$1,828.72	$1,861.13	$4,030.37
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $2,791.70 / $3,657.44 / $3,657.44	Professional		$2,791.70	$3,657.44	$3,657.44
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,828.71 / $2,721.51 / $5,747.01	Professional		$1,828.71	$2,721.51	$5,747.01
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,828.71 / $1,828.71 / $15,218.75	Facility		$1,828.71	$1,828.71	$15,218.75
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,828.71 / $1,828.71 / $1,828.71	Professional		$1,828.71	$1,828.71	$1,828.71
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,567.52 / $2,567.52 / $5,205.55	Professional		$2,567.52	$2,567.52	$5,205.55
United Facility/Professional Professional Modifier Low / Median / High Price $1,828.72 / $1,828.72 / $2,743.08	Professional		$1,828.72	$1,828.72	$2,743.08