Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $400.69 / $1,317.50 / $1,894.00	Facility		$400.69	$1,317.50	$1,894.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.84 / $254.90 / $454.29	Facility	26	$126.84	$254.90	$454.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $341.43 / $400.69 / $1,140.00	Professional		$341.43	$400.69	$1,140.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $126.20 / $159.82 / $670.00	Professional	26	$126.20	$159.82	$670.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $219.38 / $273.86 / $995.16	Professional	TC	$219.38	$273.86	$995.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $350.97 / $1,015.27 / $2,666.22	Professional		$350.97	$1,015.27	$2,666.22
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $124.47 / $334.86 / $858.65	Professional	26	$124.47	$334.86	$858.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $226.50 / $693.89 / $1,660.76	Professional	TC	$226.50	$693.89	$1,660.76
CareSource Facility/Professional Professional Modifier Low / Median / High Price $276.99 / $455.53 / $732.53	Professional		$276.99	$455.53	$732.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,038.08 / $1,213.08 / $1,956.67	Facility		$1,038.08	$1,213.08	$1,956.67
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $319.00 / $372.77 / $601.27	Facility	26	$319.00	$372.77	$601.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $492.14 / $1,217.76 / $1,537.61	Professional		$492.14	$1,217.76	$1,537.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $185.68 / $387.99 / $510.75	Professional	26	$185.68	$387.99	$510.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $323.35 / $829.77 / $1,034.45	Professional	TC	$323.35	$829.77	$1,034.45
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $363.33 / $468.81 / $710.15	Facility		$363.33	$468.81	$710.15
Medica Facility/Professional Facility Modifier Low / Median / High Price $396.36 / $2,247.00 / $4,793.00	Facility		$396.36	$2,247.00	$4,793.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $385.46 / $944.35 / $2,015.70	Professional		$385.46	$944.35	$2,015.70
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $145.47 / $341.85 / $744.34	Professional	26	$145.47	$341.85	$744.34
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $250.30 / $552.61 / $1,327.22	Professional	TC	$250.30	$552.61	$1,327.22
Molina Facility/Professional Professional Modifier Low / Median / High Price $108.32 / $299.49 / $783.25	Professional		$108.32	$299.49	$783.25
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $363.33 / $468.81 / $710.15	Facility		$363.33	$468.81	$710.15
Quartz Facility/Professional Professional Modifier Low / Median / High Price $699.40 / $1,076.00 / $1,381.80	Professional		$699.40	$1,076.00	$1,381.80
Quartz Facility/Professional Facility Modifier Low / Median / High Price $1,649.63 / $1,649.63 / $1,649.63	Facility		$1,649.63	$1,649.63	$1,649.63
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $564.64 / $564.64 / $564.64	Facility	26	$564.64	$564.64	$564.64
Quartz Facility/Professional Professional Modifier Low / Median / High Price $542.67 / $1,819.75 / $2,844.40	Professional		$542.67	$1,819.75	$2,844.40
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $172.90 / $621.54 / $930.32	Professional	26	$172.90	$621.54	$930.32
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $369.78 / $1,198.15 / $1,914.08	Professional	TC	$369.78	$1,198.15	$1,914.08
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,680.49 / $3,411.34 / $3,411.34	Professional		$1,680.49	$3,411.34	$3,411.34
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $577.45 / $611.04 / $679.35	Professional	26	$577.45	$611.04	$679.35
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $949.20 / $1,069.45 / $1,116.71	Professional	TC	$949.20	$1,069.45	$1,116.71
United Facility/Professional Facility Modifier Low / Median / High Price $2,367.00 / $3,088.30 / $4,295.00	Facility		$2,367.00	$3,088.30	$4,295.00
United Facility/Professional Professional Modifier Low / Median / High Price $399.31 / $1,065.85 / $1,816.29	Professional		$399.31	$1,065.85	$1,816.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $146.34 / $410.13 / $604.55	Professional	26	$146.34	$410.13	$604.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $252.99 / $683.33 / $1,195.92	Professional	TC	$252.99	$683.33	$1,195.92