Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,362.48 / $1,362.48 / $1,362.48	Facility		$1,362.48	$1,362.48	$1,362.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,110.58 / $1,362.48 / $2,262.21	Professional		$1,110.58	$1,362.48	$2,262.21
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,700.85 / $2,970.94 / $4,915.55	Facility		$2,700.85	$2,970.94	$4,915.55
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,430.76 / $2,511.79 / $3,322.04	Professional		$2,430.76	$2,511.79	$3,322.04
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,942.99 / $5,779.82 / $5,779.82	Facility		$1,942.99	$5,779.82	$5,779.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,747.16 / $5,583.46 / $11,273.49	Facility		$1,747.16	$5,583.46	$11,273.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,275.43 / $3,914.06 / $5,111.58	Professional		$1,275.43	$3,914.06	$5,111.58
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $728.07 / $2,043.72 / $3,105.98	Facility		$728.07	$2,043.72	$3,105.98
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $1,546.45 / $2,281.30 / $3,241.02	Professional		$1,546.45	$2,281.30	$3,241.02
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,260.32 / $2,700.85 / $11,750.92	Facility		$1,260.32	$2,700.85	$11,750.92
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,150.36 / $1,698.83 / $2,940.89	Professional		$1,150.36	$1,698.83	$2,940.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $65.00 / $85.00	Professional		$50.00	$65.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $728.07 / $2,043.72 / $3,105.98	Facility		$728.07	$2,043.72	$3,105.98
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $1,546.45 / $2,281.30 / $3,241.02	Professional		$1,546.45	$2,281.30	$3,241.02
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,700.85 / $4,156.51 / $6,766.95	Professional		$2,700.85	$4,156.51	$6,766.95
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,747.16 / $5,275.10 / $11,750.92	Facility		$1,747.16	$5,275.10	$11,750.92
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,275.43 / $1,747.16 / $13,013.65	Professional		$1,275.43	$1,747.16	$13,013.65
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,700.85 / $2,700.85 / $2,700.85	Professional		$2,700.85	$2,700.85	$2,700.85
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,700.85 / $2,700.85 / $2,700.85	Professional		$2,700.85	$2,700.85	$2,700.85
United Facility/Professional Professional Modifier Low / Median / High Price $939.81 / $1,620.51 / $2,394.62	Professional		$939.81	$1,620.51	$2,394.62