Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,631.59 / $1,631.59 / $1,631.59	Facility		$1,631.59	$1,631.59	$1,631.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,375.33 / $1,631.59 / $2,775.29	Professional		$1,375.33	$1,631.59	$2,775.29
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,234.32 / $3,557.75 / $5,886.46	Facility		$3,234.32	$3,557.75	$5,886.46
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,910.88 / $3,007.92 / $3,978.21	Professional		$2,910.88	$3,007.92	$3,978.21
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,326.77 / $6,921.44 / $6,921.44	Facility		$2,326.77	$6,921.44	$6,921.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,721.98 / $7,141.07 / $13,500.19	Facility		$1,721.98	$7,141.07	$13,500.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,257.05 / $4,687.03 / $6,121.21	Professional		$1,257.05	$4,687.03	$6,121.21
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $887.57 / $2,447.39 / $3,719.47	Facility		$887.57	$2,447.39	$3,719.47
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,851.90 / $3,234.32 / $3,881.18	Professional		$1,851.90	$3,234.32	$3,881.18
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,536.42 / $3,234.32 / $14,785.52	Facility		$1,536.42	$3,234.32	$14,785.52
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,456.91 / $2,071.00 / $3,521.78	Professional		$1,456.91	$2,071.00	$3,521.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $2,182.69	Professional		$50.00	$70.00	$2,182.69
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $887.57 / $2,447.39 / $3,719.47	Facility		$887.57	$2,447.39	$3,719.47
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,851.90 / $3,234.32 / $3,881.18	Professional		$1,851.90	$3,234.32	$3,881.18
Quartz Facility/Professional Professional Modifier Low / Median / High Price $3,234.32 / $4,977.51 / $8,249.41	Professional		$3,234.32	$4,977.51	$8,249.41
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,721.98 / $6,317.04 / $14,785.52	Facility		$1,721.98	$6,317.04	$14,785.52
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,257.05 / $1,721.98 / $17,561.62	Professional		$1,257.05	$1,721.98	$17,561.62
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,234.32 / $3,234.32 / $3,234.32	Professional		$3,234.32	$3,234.32	$3,234.32
Security Health Facility/Professional Professional Modifier Low / Median / High Price $3,234.32 / $3,234.32 / $3,234.32	Professional		$3,234.32	$3,234.32	$3,234.32
United Facility/Professional Facility Modifier Low / Median / High Price $4,409.26 / $4,409.26 / $4,409.26	Facility		$4,409.26	$4,409.26	$4,409.26
United Facility/Professional Professional Modifier Low / Median / High Price $1,242.59 / $2,068.92 / $3,437.09	Professional		$1,242.59	$2,068.92	$3,437.09