Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $200.56 / $419.58 / $1,894.00	Facility		$200.56	$419.58	$1,894.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.28 / $80.80 / $144.00	Facility	26	$40.28	$80.80	$144.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.13 / $213.94 / $722.20	Professional		$140.13	$213.94	$722.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.63 / $50.67 / $433.50	Professional	26	$37.63	$50.67	$433.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $98.17 / $160.28 / $595.12	Professional	TC	$98.17	$160.28	$595.12
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,139.00 / $1,183.00 / $1,530.00	Facility		$1,139.00	$1,183.00	$1,530.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $138.63 / $457.13 / $1,205.33	Professional		$138.63	$457.13	$1,205.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.71 / $105.20 / $272.08	Professional	26	$39.71	$105.20	$272.08
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $98.15 / $356.18 / $876.74	Professional	TC	$98.15	$356.18	$876.74
CareSource Facility/Professional Facility Modifier Low / Median / High Price $46.33 / $149.33 / $215.24	Facility		$46.33	$149.33	$215.24
CareSource Facility/Professional Professional Modifier Low / Median / High Price $43.10 / $159.35 / $332.69	Professional		$43.10	$159.35	$332.69
Cigna Facility/Professional Facility Modifier Low / Median / High Price $516.34 / $603.39 / $973.24	Facility		$516.34	$603.39	$973.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.93 / $117.94 / $190.23	Facility	26	$100.93	$117.94	$190.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $252.17 / $602.16 / $723.69	Professional		$252.17	$602.16	$723.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.86 / $122.88 / $162.58	Professional	26	$58.86	$122.88	$162.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $176.28 / $479.30 / $561.11	Professional	TC	$176.28	$479.30	$561.11
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $169.24 / $200.56 / $947.60	Facility		$169.24	$200.56	$947.60
Medica Facility/Professional Facility Modifier Low / Median / High Price $169.24 / $947.60 / $1,789.00	Facility		$169.24	$947.60	$1,789.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $158.66 / $433.26 / $956.00	Professional		$158.66	$433.26	$956.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $46.39 / $140.28 / $907.84	Professional	26	$46.39	$140.28	$907.84
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $107.08 / $317.04 / $1,117.24	Professional	TC	$107.08	$317.04	$1,117.24
Molina Facility/Professional Professional Modifier Low / Median / High Price $54.35 / $143.96 / $361.96	Professional		$54.35	$143.96	$361.96
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $169.24 / $200.56 / $947.60	Facility		$169.24	$200.56	$947.60
Quartz Facility/Professional Professional Modifier Low / Median / High Price $323.70 / $458.58 / $588.79	Professional		$323.70	$458.58	$588.79
Quartz Facility/Professional Facility Modifier Low / Median / High Price $2,922.50 / $2,922.50 / $2,922.50	Facility		$2,922.50	$2,922.50	$2,922.50
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $181.86 / $181.86 / $181.86	Facility	26	$181.86	$181.86	$181.86
Quartz Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $858.94 / $1,531.99	Professional		$268.35	$858.94	$1,531.99
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $54.76 / $257.93 / $907.84	Professional	26	$54.76	$257.93	$907.84
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $213.60 / $645.08 / $1,117.24	Professional	TC	$213.60	$645.08	$1,117.24
Security Health Facility/Professional Professional Modifier Low / Median / High Price $590.97 / $1,138.64 / $1,138.64	Professional		$590.97	$1,138.64	$1,138.64
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $191.29 / $215.61 / $270.01	Professional	26	$191.29	$215.61	$270.01
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $359.85 / $375.36 / $572.54	Professional	TC	$359.85	$375.36	$572.54
United Facility/Professional Facility Modifier Low / Median / High Price $1,034.00 / $1,423.00 / $2,202.90	Facility		$1,034.00	$1,423.00	$2,202.90
United Facility/Professional Professional Modifier Low / Median / High Price $161.09 / $433.26 / $764.30	Professional		$161.09	$433.26	$764.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.06 / $132.19 / $196.58	Professional	26	$43.06	$132.19	$196.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $121.62 / $317.04 / $530.91	Professional	TC	$121.62	$317.04	$530.91