Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $237.38 / $503.74 / $856.38	Facility		$237.38	$503.74	$856.38
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.00 / $55.35 / $56.00	Facility	26	$40.00	$55.35	$56.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.17 / $237.38 / $867.00	Professional		$75.17	$237.38	$867.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.88 / $40.00 / $280.50	Professional	26	$23.88	$40.00	$280.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.89 / $90.02 / $292.61	Professional	TC	$49.89	$90.02	$292.61
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $98.60 / $228.39 / $727.28	Professional		$98.60	$228.39	$727.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.81 / $59.59 / $172.85	Professional	26	$25.81	$59.59	$172.85
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $71.17 / $177.97 / $539.34	Professional	TC	$71.17	$177.97	$539.34
CareSource Facility/Professional Facility Modifier Low / Median / High Price $31.19 / $102.20 / $147.15	Facility		$31.19	$102.20	$147.15
CareSource Facility/Professional Professional Modifier Low / Median / High Price $29.40 / $109.80 / $227.44	Professional		$29.40	$109.80	$227.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $317.19 / $370.67 / $597.87	Facility		$317.19	$370.67	$597.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.29 / $82.14 / $132.47	Facility	26	$70.29	$82.14	$132.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $163.52 / $380.80 / $463.36	Professional		$163.52	$380.80	$463.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.13 / $93.15 / $105.85	Professional	26	$38.13	$93.15	$105.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.40 / $288.06 / $357.48	Professional	TC	$125.40	$288.06	$357.48
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $101.17 / $141.13 / $283.77	Facility		$101.17	$141.13	$283.77
Medica Facility/Professional Facility Modifier Low / Median / High Price $105.50 / $226.83 / $544.80	Facility		$105.50	$226.83	$544.80
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $560.00 / $560.00 / $560.00	Facility	26	$560.00	$560.00	$560.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $92.32 / $188.38 / $500.54	Professional		$92.32	$188.38	$500.54
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $28.33 / $57.48 / $150.18	Professional	26	$28.33	$57.48	$150.18
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $64.20 / $125.22 / $350.36	Professional	TC	$64.20	$125.22	$350.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $114.12 / $253.98	Professional		$50.00	$114.12	$253.98
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $101.17 / $141.13 / $283.77	Facility		$101.17	$141.13	$283.77
Quartz Facility/Professional Professional Modifier Low / Median / High Price $122.66 / $272.87 / $405.21	Professional		$122.66	$272.87	$405.21
Quartz Facility/Professional Facility Modifier Low / Median / High Price $516.20 / $516.20 / $516.20	Facility		$516.20	$516.20	$516.20
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $136.28 / $136.28 / $136.28	Facility	26	$136.28	$136.28	$136.28
Quartz Facility/Professional Professional Modifier Low / Median / High Price $171.74 / $522.75 / $752.82	Professional		$171.74	$522.75	$752.82
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $39.24 / $136.85 / $169.69	Professional	26	$39.24	$136.85	$169.69
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $132.50 / $385.90 / $583.14	Professional	TC	$132.50	$385.90	$583.14
Security Health Facility/Professional Professional Modifier Low / Median / High Price $180.52 / $726.57 / $726.57	Professional		$180.52	$726.57	$726.57
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.29 / $55.21 / $152.09	Professional	26	$26.29	$55.21	$152.09
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $115.30 / $125.31 / $290.37	Professional	TC	$115.30	$125.31	$290.37
United Facility/Professional Professional Modifier Low / Median / High Price $100.01 / $219.56 / $458.19	Professional		$100.01	$219.56	$458.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.33 / $57.48 / $119.95	Professional	26	$28.33	$57.48	$119.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $65.64 / $125.31 / $338.24	Professional	TC	$65.64	$125.31	$338.24