Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,690.16 / $1,690.16 / $1,690.16	Facility		$1,690.16	$1,690.16	$1,690.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,640.93 / $1,690.16 / $1,805.02	Professional		$1,640.93	$1,690.16	$1,805.02
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,640.93 / $1,640.93 / $2,625.48	Professional		$1,640.93	$1,640.93	$2,625.48
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,246.58 / $2,609.08 / $2,625.49	Facility		$2,246.58	$2,609.08	$2,625.49
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,188.29 / $4,003.23 / $5,673.96	Facility		$2,188.29	$4,003.23	$5,673.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.08 / $1,640.93 / $2,366.63	Professional		$338.08	$1,640.93	$2,366.63
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $1,640.93 / $1,690.16 / $2,585.94	Facility		$1,640.93	$1,690.16	$2,585.94
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,640.93 / $1,690.16 / $2,585.94	Facility		$1,640.93	$1,690.16	$2,585.94
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,640.93 / $1,640.93 / $3,445.95	Professional		$1,640.93	$1,640.93	$3,445.95
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $58.40 / $85.00	Professional		$50.00	$58.40	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $1,640.93 / $1,690.16 / $2,585.94	Facility		$1,640.93	$1,690.16	$2,585.94
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,640.93 / $1,640.93 / $3,070.53	Professional		$1,640.93	$1,640.93	$3,070.53
Quartz Facility/Professional Facility Modifier Low / Median / High Price $322.16 / $1,773.90 / $5,493.04	Facility		$322.16	$1,773.90	$5,493.04
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,640.93 / $2,236.65 / $5,857.77	Professional		$1,640.93	$2,236.65	$5,857.77
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,303.87 / $2,303.87 / $2,303.87	Professional		$2,303.87	$2,303.87	$2,303.87
United Facility/Professional Professional Modifier Low / Median / High Price $1,640.93 / $1,640.93 / $2,246.76	Professional		$1,640.93	$1,640.93	$2,246.76