Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $188.14 / $373.50 / $655.65	Facility		$188.14	$373.50	$655.65
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 Facility Modifier TC Low / Median / High Price $43.08 / $302.35 / $404.10	Facility	TC	$43.08	$302.35	$404.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.74 / $59.29 / $284.75	Professional		$36.74	$59.29	$284.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.15 / $24.56 / $97.75	Professional	26	$10.15	$24.56	$97.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.05 / $43.08 / $150.01	Professional	TC	$25.05	$43.08	$150.01
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.13 / $78.19 / $215.70	Professional		$36.13	$78.19	$215.70
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 $24.88 / $55.61 / $156.93	Professional	TC	$24.88	$55.61	$156.93
CareSource Facility/Professional Facility Modifier Low / Median / High Price $11.11 / $33.38 / $48.52	Facility		$11.11	$33.38	$48.52
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.95 / $34.67 / $53.64	Professional		$11.95	$34.67	$53.64
Cigna Facility/Professional Facility Modifier Low / Median / High Price $107.23 / $125.31 / $166.55	Facility		$107.23	$125.31	$166.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.93 / $32.64 / $43.39	Facility	26	$27.93	$32.64	$43.39
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $79.30 / $92.67 / $123.16	Facility	TC	$79.30	$92.67	$123.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.77 / $139.15 / $158.13	Professional		$39.77	$139.15	$158.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.20 / $37.90 / $43.08	Professional	26	$12.20	$37.90	$43.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.39 / $101.24 / $115.05	Professional	TC	$27.39	$101.24	$115.05
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $33.92 / $55.44 / $81.67	Facility		$33.92	$55.44	$81.67
Medica Facility/Professional Facility Modifier Low / Median / High Price $34.46 / $61.83 / $287.39	Facility		$34.46	$61.83	$287.39
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $198.00	Facility	26	$100.00	$100.00	$198.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $131.69 / $275.20 / $500.38	Facility	TC	$131.69	$275.20	$500.38
Medica Facility/Professional Professional Modifier Low / Median / High Price $40.72 / $95.21 / $254.22	Professional		$40.72	$95.21	$254.22
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $12.70 / $31.50 / $90.81	Professional	26	$12.70	$31.50	$90.81
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $27.40 / $63.96 / $195.00	Professional	TC	$27.40	$63.96	$195.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.34 / $40.15 / $77.04	Professional		$19.34	$40.15	$77.04
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $33.92 / $59.29 / $81.67	Facility		$33.92	$59.29	$81.67
Quartz Facility/Professional Professional Modifier Low / Median / High Price $77.34 / $115.88 / $197.66	Professional		$77.34	$115.88	$197.66
Quartz Facility/Professional Facility Modifier Low / Median / High Price $95.44 / $342.77 / $342.77	Facility		$95.44	$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 Facility Modifier TC Low / Median / High Price $100.00 / $131.69 / $131.69	Facility	TC	$100.00	$131.69	$131.69
Quartz Facility/Professional Professional Modifier Low / Median / High Price $64.45 / $183.00 / $254.22	Professional		$64.45	$183.00	$254.22
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $17.55 / $55.70 / $90.81	Professional	26	$17.55	$55.70	$90.81
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $44.54 / $127.30 / $195.00	Professional	TC	$44.54	$127.30	$195.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $70.90 / $224.50 / $247.92	Professional		$70.90	$224.50	$247.92
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $30.35 / $63.17	Professional	26	$24.78	$30.35	$63.17
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.12 / $59.42 / $138.21	Professional	TC	$46.12	$59.42	$138.21
United Facility/Professional Facility Modifier Low / Median / High Price $104.04 / $104.04 / $104.04	Facility		$104.04	$104.04	$104.04
United Facility/Professional Professional Modifier Low / Median / High Price $38.61 / $84.31 / $176.22	Professional		$38.61	$84.31	$176.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.74 / $23.95 / $48.82	Professional	26	$11.74	$23.95	$48.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.07 / $59.79 / $103.11	Professional	TC	$27.07	$59.79	$103.11