Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $192.00 / $634.90 / $958.16	Facility		$192.00	$634.90	$958.16
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.13 / $46.63 / $56.76	Facility	26	$28.13	$46.63	$56.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.34 / $193.54 / $776.00	Professional		$107.34	$193.54	$776.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.98 / $63.90 / $248.00	Professional	26	$24.98	$63.90	$248.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $47.34 / $63.23 / $151.94	Professional	52	$47.34	$63.23	$151.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $80.30 / $126.41 / $469.72	Professional	TC	$80.30	$126.41	$469.72
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.72 / $166.96 / $616.82	Professional		$107.72	$166.96	$616.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.16 / $42.48 / $152.63	Professional	26	$26.16	$42.48	$152.63
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.55 / $126.41 / $464.18	Professional	TC	$81.55	$126.41	$464.18
CareSource Facility/Professional Facility Modifier Low / Median / High Price $27.83 / $97.23 / $137.84	Facility		$27.83	$97.23	$137.84
CareSource Facility/Professional Professional Modifier Low / Median / High Price $28.58 / $91.49 / $134.41	Professional		$28.58	$91.49	$134.41
Cigna Facility/Professional Facility Modifier Low / Median / High Price $301.88 / $352.77 / $541.15	Facility		$301.88	$352.77	$541.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.29 / $82.14 / $126.00	Facility	26	$70.29	$82.14	$126.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $122.15 / $387.93 / $440.83	Professional		$122.15	$387.93	$440.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.64 / $93.26 / $105.98	Professional	26	$31.64	$93.26	$105.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $90.60 / $294.67 / $334.85	Professional	TC	$90.60	$294.67	$334.85
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $95.46 / $144.74 / $295.06	Facility		$95.46	$144.74	$295.06
Medica Facility/Professional Facility Modifier Low / Median / High Price $96.92 / $215.64 / $587.00	Facility		$96.92	$215.64	$587.00
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $122.00 / $122.00 / $314.50	Facility	26	$122.00	$122.00	$314.50
Medica Facility/Professional Professional Modifier Low / Median / High Price $119.04 / $236.16 / $726.73	Professional		$119.04	$236.16	$726.73
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $30.29 / $67.34 / $255.92	Professional	26	$30.29	$67.34	$255.92
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $89.14 / $171.88 / $554.94	Professional	TC	$89.14	$171.88	$554.94
Molina Facility/Professional Professional Modifier Low / Median / High Price $38.69 / $109.12 / $253.98	Professional		$38.69	$109.12	$253.98
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $96.92 / $141.82 / $295.06	Facility		$96.92	$141.82	$295.06
Quartz Facility/Professional Professional Modifier Low / Median / High Price $204.70 / $271.72 / $492.00	Professional		$204.70	$271.72	$492.00
Quartz Facility/Professional Facility Modifier Low / Median / High Price $290.48 / $514.16 / $514.16	Facility		$290.48	$514.16	$514.16
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $122.00 / $122.00	Facility	26	$100.00	$122.00	$122.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $163.38 / $560.60 / $726.73	Professional		$163.38	$560.60	$726.73
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $39.28 / $138.75 / $255.92	Professional	26	$39.28	$138.75	$255.92
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $124.11 / $421.85 / $554.94	Professional	TC	$124.11	$421.85	$554.94
Security Health Facility/Professional Professional Modifier Low / Median / High Price $237.76 / $691.24 / $691.24	Professional		$237.76	$691.24	$691.24
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.30 / $102.87 / $152.24	Professional	26	$81.30	$102.87	$152.24
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $121.38 / $251.38 / $538.35	Professional	TC	$121.38	$251.38	$538.35
United Facility/Professional Facility Modifier Low / Median / High Price $119.18 / $119.18 / $187.89	Facility		$119.18	$119.18	$187.89
United Facility/Professional Professional Modifier Low / Median / High Price $118.91 / $224.22 / $491.37	Professional		$118.91	$224.22	$491.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.87 / $56.04 / $121.62	Professional	26	$28.87	$56.04	$121.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.14 / $159.51 / $369.75	Professional	TC	$89.14	$159.51	$369.75