Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.59 / $258.04 / $380.80	Facility		$63.59	$258.04	$380.80
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.21 / $18.64 / $22.52	Facility	26	$16.21	$18.64	$22.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.19 / $52.35 / $171.53	Professional		$29.19	$52.35	$171.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.65 / $16.52 / $68.40	Professional	26	$9.65	$16.52	$68.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.41 / $34.44 / $156.53	Professional	TC	$22.41	$34.44	$156.53
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $34.02 / $72.94 / $199.34	Professional		$34.02	$72.94	$199.34
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.46 / $24.16 / $67.31	Professional	26	$10.46	$24.16	$67.31
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.24 / $50.87 / $142.38	Professional	TC	$22.24	$50.87	$142.38
CareSource Facility/Professional Facility Modifier Low / Median / High Price $11.11 / $29.93 / $44.94	Facility		$11.11	$29.93	$44.94
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.95 / $31.08 / $49.62	Professional		$11.95	$31.08	$49.62
Cigna Facility/Professional Facility Modifier Low / Median / High Price $99.12 / $115.83 / $153.94	Facility		$99.12	$115.83	$153.94
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.03 / $31.59 / $41.99	Facility	26	$27.03	$31.59	$41.99
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.47 / $128.59 / $146.13	Professional		$37.47	$128.59	$146.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.20 / $36.72 / $41.74	Professional	26	$12.20	$36.72	$41.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.74 / $91.86 / $104.39	Professional	TC	$25.74	$91.86	$104.39
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $32.03 / $54.74 / $76.13	Facility		$32.03	$54.74	$76.13
Medica Facility/Professional Facility Modifier Low / Median / High Price $31.69 / $55.30 / $225.13	Facility		$31.69	$55.30	$225.13
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $36.65 / $85.91 / $236.90	Professional		$36.65	$85.91	$236.90
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $12.47 / $28.98 / $82.56	Professional	26	$12.47	$28.98	$82.56
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $24.54 / $57.96 / $190.00	Professional	TC	$24.54	$57.96	$190.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.34 / $36.36 / $74.33	Professional		$19.34	$36.36	$74.33
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $32.03 / $55.30 / $76.13	Facility		$32.03	$55.30	$76.13
Quartz Facility/Professional Professional Modifier Low / Median / High Price $71.50 / $107.12 / $176.68	Professional		$71.50	$107.12	$176.68
Quartz Facility/Professional Facility Modifier Low / Median / High Price $87.35 / $342.77 / $342.77	Facility		$87.35	$342.77	$342.77
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $56.50 / $171.00 / $236.90	Professional		$56.50	$171.00	$236.90
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $17.02 / $55.70 / $82.56	Professional	26	$17.02	$55.70	$82.56
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $38.68 / $115.30 / $190.00	Professional	TC	$38.68	$115.30	$190.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $70.90 / $208.87 / $229.12	Professional		$70.90	$208.87	$229.12
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $31.35 / $61.03	Professional	26	$24.78	$31.35	$61.03
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.12 / $58.36 / $123.18	Professional	TC	$46.12	$58.36	$123.18
United Facility/Professional Professional Modifier Low / Median / High Price $36.09 / $76.18 / $149.88	Professional		$36.09	$76.18	$149.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.27 / $68.23 / $95.00	Professional	26	$16.27	$68.23	$95.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.49 / $50.70 / $101.06	Professional	TC	$24.49	$50.70	$101.06