Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $116.74 / $153.96 / $486.00	Professional		$116.74	$153.96	$486.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.36 / $80.73 / $504.45	Professional	26	$52.36	$80.73	$504.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.86 / $89.35 / $213.57	Professional	TC	$61.86	$89.35	$213.57
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.22 / $412.83 / $867.01	Professional		$63.22	$412.83	$867.01
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.95 / $200.16 / $414.56	Professional	26	$29.95	$200.16	$414.56
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.26 / $242.78 / $452.46	Professional	TC	$33.26	$242.78	$452.46
CareSource Facility/Professional Facility Modifier Low / Median / High Price $64.06 / $95.77 / $191.80	Facility		$64.06	$95.77	$191.80
CareSource Facility/Professional Professional Modifier Low / Median / High Price $64.06 / $105.35 / $191.80	Professional		$64.06	$105.35	$191.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $534.94 / $607.89 / $862.84	Facility		$534.94	$607.89	$862.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $213.77 / $242.91 / $344.80	Facility	26	$213.77	$242.91	$344.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.92 / $227.21 / $500.54	Professional		$79.92	$227.21	$500.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.38 / $88.87 / $219.36	Professional	26	$33.38	$88.87	$219.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.04 / $134.41 / $284.82	Professional	TC	$40.04	$134.41	$284.82
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $106.74 / $187.09 / $479.49	Facility		$106.74	$187.09	$479.49
Medica Facility/Professional Facility Modifier Low / Median / High Price $106.74 / $187.50 / $498.66	Facility		$106.74	$187.50	$498.66
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $305.79 / $305.79 / $305.79	Facility	26	$305.79	$305.79	$305.79
Medica Facility/Professional Professional Modifier Low / Median / High Price $110.16 / $179.45 / $1,961.76	Professional		$110.16	$179.45	$1,961.76
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $57.67 / $165.81 / $434.05	Professional	26	$57.67	$165.81	$434.05
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $54.94 / $99.12 / $557.54	Professional	TC	$54.94	$99.12	$557.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $47.89 / $70.00 / $329.53	Professional		$47.89	$70.00	$329.53
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $106.74 / $187.09 / $479.49	Facility		$106.74	$187.09	$479.49
Quartz Facility/Professional Professional Modifier Low / Median / High Price $197.64 / $396.45 / $556.04	Professional		$197.64	$396.45	$556.04
Quartz Facility/Professional Facility Modifier Low / Median / High Price $321.74 / $321.74 / $778.10	Facility		$321.74	$321.74	$778.10
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $131.84 / $131.84 / $305.79	Facility	26	$131.84	$131.84	$305.79
Quartz Facility/Professional Professional Modifier Low / Median / High Price $82.85 / $753.75 / $1,961.76	Professional		$82.85	$753.75	$1,961.76
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $36.11 / $360.45 / $434.05	Professional	26	$36.11	$360.45	$434.05
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $47.47 / $393.30 / $557.54	Professional	TC	$47.47	$393.30	$557.54
Security Health Facility/Professional Professional Modifier Low / Median / High Price $182.52 / $433.14 / $863.99	Professional		$182.52	$433.14	$863.99
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $91.44 / $91.44 / $259.77	Professional	26	$91.44	$91.44	$259.77
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.14 / $58.14 / $277.10	Professional	TC	$58.14	$58.14	$277.10
United Facility/Professional Professional Modifier Low / Median / High Price $110.16 / $150.75 / $434.16	Professional		$110.16	$150.75	$434.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.62 / $72.09 / $217.08	Professional	26	$49.62	$72.09	$217.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.94 / $78.66 / $253.01	Professional	TC	$54.94	$78.66	$253.01