Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.34 / $130.00 / $415.43	Professional		$83.34	$130.00	$415.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.98 / $50.84 / $325.50	Professional	26	$19.98	$50.84	$325.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.35 / $83.94 / $298.92	Professional	TC	$63.35	$83.94	$298.92
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.74 / $294.07 / $578.13	Professional		$39.74	$294.07	$578.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.23 / $76.91 / $156.06	Professional	26	$11.23	$76.91	$156.06
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.51 / $210.97 / $410.63	Professional	TC	$28.51	$210.97	$410.63
CareSource Facility/Professional Facility Modifier Low / Median / High Price $24.38 / $79.45 / $124.61	Facility		$24.38	$79.45	$124.61
CareSource Facility/Professional Professional Modifier Low / Median / High Price $24.38 / $79.45 / $124.61	Professional		$24.38	$79.45	$124.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $362.24 / $411.64 / $584.28	Facility		$362.24	$411.64	$584.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.08 / $92.14 / $130.78	Facility	26	$81.08	$92.14	$130.78
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $281.16 / $319.50 / $453.50	Facility	TC	$281.16	$319.50	$453.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.92 / $152.62 / $339.54	Professional		$51.92	$152.62	$339.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.76 / $35.57 / $83.49	Professional	26	$12.76	$35.57	$83.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.72 / $116.12 / $255.98	Professional	TC	$39.72	$116.12	$255.98
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $33.00 / $130.00 / $311.52	Facility		$33.00	$130.00	$311.52
Medica Facility/Professional Facility Modifier Low / Median / High Price $33.00 / $130.00 / $311.52	Facility		$33.00	$130.00	$311.52
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $116.58 / $116.58 / $116.58	Facility	26	$116.58	$116.58	$116.58
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $390.55 / $390.55 / $390.55	Facility	TC	$390.55	$390.55	$390.55
Medica Facility/Professional Professional Modifier Low / Median / High Price $76.54 / $141.12 / $715.47	Professional		$76.54	$141.12	$715.47
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $21.71 / $62.42 / $162.69	Professional	26	$21.71	$62.42	$162.69
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $60.10 / $120.19 / $552.78	Professional	TC	$60.10	$120.19	$552.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $39.72 / $65.00 / $278.27	Professional		$39.72	$65.00	$278.27
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $33.00 / $130.00 / $311.52	Facility		$33.00	$130.00	$311.52
Quartz Facility/Professional Professional Modifier Low / Median / High Price $87.89 / $258.39 / $362.40	Professional		$87.89	$258.39	$362.40
Quartz Facility/Professional Facility Modifier Low / Median / High Price $216.06 / $216.06 / $507.12	Facility		$216.06	$216.06	$507.12
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $116.58	Facility	26	$100.00	$100.00	$116.58
Quartz Facility/Professional Facility Modifier TC Low / Median / High Price $165.88 / $165.88 / $390.55	Facility	TC	$165.88	$165.88	$390.55
Quartz Facility/Professional Professional Modifier Low / Median / High Price $59.75 / $511.30 / $715.47	Professional		$59.75	$511.30	$715.47
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $13.52 / $135.69 / $162.69	Professional	26	$13.52	$135.69	$162.69
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $41.47 / $375.60 / $552.78	Professional	TC	$41.47	$375.60	$552.78
Security Health Facility/Professional Professional Modifier Low / Median / High Price $82.40 / $82.40 / $580.23	Professional		$82.40	$82.40	$580.23
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.09 / $13.09 / $99.29	Professional	26	$13.09	$13.09	$99.29
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.05 / $28.05 / $243.40	Professional	TC	$28.05	$28.05	$243.40
United Facility/Professional Professional Modifier Low / Median / High Price $72.11 / $102.26 / $306.02	Professional		$72.11	$102.26	$306.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.89 / $27.14 / $78.16	Professional	26	$19.89	$27.14	$78.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.18 / $75.12 / $217.33	Professional	TC	$58.18	$75.12	$217.33