Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,169.92 / $2,169.92 / $2,169.92	Facility		$2,169.92	$2,169.92	$2,169.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,459.29 / $2,169.92 / $3,602.89	Professional		$1,459.29	$2,169.92	$3,602.89
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,301.46 / $4,731.60 / $7,828.66	Facility		$4,301.46	$4,731.60	$7,828.66
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,871.31 / $4,000.36 / $5,290.79	Professional		$3,871.31	$4,000.36	$5,290.79
CareSource Facility/Professional Facility Modifier Low / Median / High Price $3,094.46 / $9,205.12 / $9,205.12	Facility		$3,094.46	$9,205.12	$9,205.12
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,782.58 / $8,893.01 / $17,955.00	Facility		$2,782.58	$8,893.01	$17,955.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,031.28 / $7,163.94 / $8,140.84	Professional		$2,031.28	$7,163.94	$8,140.84
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,092.64 / $3,254.88 / $4,946.68	Facility		$1,092.64	$3,254.88	$4,946.68
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $2,462.92 / $3,881.14 / $5,161.75	Professional		$2,462.92	$3,881.14	$5,161.75
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,891.40 / $4,301.46 / $17,790.55	Facility		$1,891.40	$4,301.46	$17,790.55
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,821.71 / $2,550.06 / $4,683.75	Professional		$1,821.71	$2,550.06	$4,683.75
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $2,854.54	Professional		$50.00	$70.00	$2,854.54
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,092.64 / $3,254.88 / $4,946.68	Facility		$1,092.64	$3,254.88	$4,946.68
Prevea360 Facility/Professional Professional Modifier Low / Median / High Price $2,462.92 / $3,881.14 / $5,161.75	Professional		$2,462.92	$3,881.14	$5,161.75
Quartz Facility/Professional Professional Modifier Low / Median / High Price $4,301.46 / $6,474.91 / $10,155.44	Professional		$4,301.46	$6,474.91	$10,155.44
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,782.58 / $8,401.28 / $17,790.55	Facility		$2,782.58	$8,401.28	$17,790.55
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,031.28 / $2,782.58 / $20,910.48	Professional		$2,031.28	$2,782.58	$20,910.48
Security Health Facility/Professional Professional Modifier Low / Median / High Price $4,301.46 / $4,301.46 / $4,301.46	Professional		$4,301.46	$4,301.46	$4,301.46
Security Health Facility/Professional Professional Modifier Low / Median / High Price $4,301.46 / $4,301.46 / $4,301.46	Professional		$4,301.46	$4,301.46	$4,301.46
United Facility/Professional Professional Modifier Low / Median / High Price $1,430.63 / $2,256.64 / $3,813.74	Professional		$1,430.63	$2,256.64	$3,813.74