Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $123.55 / $561.15 / $1,156.44	Facility		$123.55	$561.15	$1,156.44
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.33 / $63.41 / $87.75	Facility	26	$45.33	$63.41	$87.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.56 / $216.00 / $882.00	Professional		$55.56	$216.00	$882.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.98 / $72.11 / $357.00	Professional	26	$28.98	$72.11	$357.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.94 / $54.42 / $240.37	Professional	TC	$23.94	$54.42	$240.37
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $55.69 / $105.99 / $359.99	Professional		$55.69	$105.99	$359.99
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.25 / $48.60 / $172.59	Professional	26	$29.25	$48.60	$172.59
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.92 / $52.99 / $169.50	Professional	TC	$23.92	$52.99	$169.50
CareSource Facility/Professional Facility Modifier Low / Median / High Price $28.11 / $39.86 / $75.94	Facility		$28.11	$39.86	$75.94
CareSource Facility/Professional Professional Modifier Low / Median / High Price $28.11 / $38.57 / $74.62	Professional		$28.11	$38.57	$74.62
Cigna Facility/Professional Facility Modifier Low / Median / High Price $155.88 / $182.17 / $279.45	Facility		$155.88	$182.17	$279.45
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.40 / $91.61 / $140.54	Facility	26	$78.40	$91.61	$140.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.12 / $204.47 / $232.35	Professional		$85.12	$204.47	$232.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.18 / $105.59 / $119.99	Professional	26	$38.18	$105.59	$119.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.43 / $98.89 / $114.41	Professional	TC	$41.43	$98.89	$114.41
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $51.06 / $109.50 / $336.67	Facility		$51.06	$109.50	$336.67
Medica Facility/Professional Facility Modifier Low / Median / High Price $51.06 / $118.06 / $785.82	Facility		$51.06	$118.06	$785.82
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $261.98 / $261.98 / $359.03	Facility	26	$261.98	$261.98	$359.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $65.50 / $176.16 / $947.00	Professional		$65.50	$176.16	$947.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $34.79 / $72.17 / $368.00	Professional	26	$34.79	$72.17	$368.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $28.07 / $83.30 / $758.00	Professional	TC	$28.07	$83.30	$758.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.84 / $60.81 / $132.11	Professional		$25.84	$60.81	$132.11
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $51.06 / $90.82 / $294.04	Facility		$51.06	$90.82	$294.04
Quartz Facility/Professional Professional Modifier Low / Median / High Price $110.47 / $167.41 / $370.51	Professional		$110.47	$167.41	$370.51
Quartz Facility/Professional Facility Modifier Low / Median / High Price $181.87 / $889.98 / $889.98	Facility		$181.87	$889.98	$889.98
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $261.98 / $261.98	Facility	26	$100.00	$261.98	$261.98
Quartz Facility/Professional Professional Modifier Low / Median / High Price $86.11 / $582.77 / $947.00	Professional		$86.11	$582.77	$947.00
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $44.46 / $156.90 / $368.00	Professional	26	$44.46	$156.90	$368.00
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $41.65 / $472.81 / $758.00	Professional	TC	$41.65	$472.81	$758.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $172.62 / $364.32 / $364.32	Professional		$172.62	$364.32	$364.32
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.86 / $118.76 / $182.36	Professional	26	$93.86	$118.76	$182.36
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $78.76 / $99.66 / $970.42	Professional	TC	$78.76	$99.66	$970.42
United Facility/Professional Professional Modifier Low / Median / High Price $65.50 / $133.66 / $268.36	Professional		$65.50	$133.66	$268.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.31 / $64.95 / $120.81	Professional	26	$34.31	$64.95	$120.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.73 / $63.61 / $197.81	Professional	TC	$26.73	$63.61	$197.81