Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,421.70 / $1,421.70 / $1,421.70	Facility		$1,421.70	$1,421.70	$1,421.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $971.77 / $1,421.70 / $2,360.56	Professional		$971.77	$1,421.70	$2,360.56
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,818.25 / $3,100.08 / $5,129.22	Facility		$2,818.25	$3,100.08	$5,129.22
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,536.42 / $2,620.96 / $3,466.44	Professional		$2,536.42	$2,620.96	$3,466.44
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,027.44 / $6,031.06 / $6,031.06	Facility		$2,027.44	$6,031.06	$6,031.06
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,823.10 / $5,826.41 / $11,763.34	Facility		$1,823.10	$5,826.41	$11,763.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,330.86 / $4,084.22 / $5,333.76	Professional		$1,330.86	$4,084.22	$5,333.76
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $751.32 / $2,132.55 / $3,240.99	Facility		$751.32	$2,132.55	$3,240.99
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,613.67 / $2,818.25 / $3,381.90	Professional		$1,613.67	$2,818.25	$3,381.90
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,300.58 / $2,818.25 / $12,483.67	Facility		$1,300.58	$2,818.25	$12,483.67
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,269.49 / $1,753.09 / $3,068.73	Professional		$1,269.49	$1,753.09	$3,068.73
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $1,574.28	Professional		$50.00	$70.00	$1,574.28
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $751.32 / $2,132.55 / $3,240.99	Facility		$751.32	$2,132.55	$3,240.99
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,613.67 / $2,818.25 / $3,381.90	Professional		$1,613.67	$2,818.25	$3,381.90
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,818.25 / $4,337.21 / $6,982.74	Professional		$2,818.25	$4,337.21	$6,982.74
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,823.10 / $5,504.40 / $12,483.67	Facility		$1,823.10	$5,504.40	$12,483.67
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,330.86 / $1,823.10 / $15,210.51	Professional		$1,330.86	$1,823.10	$15,210.51
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,818.25 / $2,818.25 / $2,818.25	Professional		$2,818.25	$2,818.25	$2,818.25
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,818.25 / $2,818.25 / $2,818.25	Professional		$2,818.25	$2,818.25	$2,818.25
United Facility/Professional Professional Modifier Low / Median / High Price $969.83 / $1,537.88 / $2,498.71	Professional		$969.83	$1,537.88	$2,498.71