Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $107.15 / $309.03	Professional		$79.43	$107.15	$309.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $331.13 / $1,047.13	Professional	26	$58.88	$331.13	$1,047.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $38.90 / $112.20	Professional	TC	$28.84	$38.90	$112.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $208.93 / $575.44	Professional		$39.81	$208.93	$575.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $141.25 / $389.05	Professional	26	$26.92	$141.25	$389.05
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $13.49 / $83.18 / $194.98	Professional	TC	$13.49	$83.18	$194.98
CareSource Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $70.79 / $128.82	Facility		$46.77	$70.79	$128.82
CareSource Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $81.28 / $144.54	Professional		$37.15	$81.28	$144.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $323.59 / $363.08 / $537.03	Facility		$323.59	$363.08	$537.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $190.55 / $213.80 / $316.23	Facility	26	$190.55	$213.80	$316.23
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $131.83 / $151.36 / $223.87	Facility	TC	$131.83	$151.36	$223.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $138.04 / $323.59	Professional		$46.77	$138.04	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $83.18 / $181.97	Professional	26	$28.84	$83.18	$181.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $54.95 / $120.23	Professional	TC	$17.38	$54.95	$120.23
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $117.49 / $295.12	Facility		$75.86	$117.49	$295.12
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $302.00	Professional		$275.42	$275.42	$302.00
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $165.96 / $181.97	Professional	26	$165.96	$165.96	$181.97
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $109.65 / $123.03	Professional	TC	$109.65	$109.65	$123.03
Medica Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $123.03 / $295.12	Facility		$75.86	$123.03	$295.12
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $275.42 / $275.42 / $275.42	Facility	26	$275.42	$275.42	$275.42
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $186.21 / $186.21 / $186.21	Facility	TC	$186.21	$186.21	$186.21
Medica Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $134.90 / $645.65	Professional		$69.18	$134.90	$645.65
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $123.03 / $380.19	Professional	26	$47.86	$123.03	$380.19
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $37.15 / $346.74	Professional	TC	$24.55	$37.15	$346.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $64.57 / $107.15	Professional		$32.36	$64.57	$107.15
Quartz Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $229.09 / $338.84	Professional		$169.82	$229.09	$338.84
Quartz Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $190.55 / $645.65	Facility		$190.55	$190.55	$645.65
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $114.82 / $380.19	Facility	26	$114.82	$114.82	$380.19
Quartz Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $100.00 / $257.04	Facility	TC	$100.00	$100.00	$257.04
Quartz Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $478.63 / $645.65	Professional		$46.77	$478.63	$645.65
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $316.23 / $380.19	Professional	26	$28.18	$316.23	$380.19
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $165.96 / $346.74	Professional	TC	$18.62	$165.96	$346.74
Security Health Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $234.42 / $524.81	Professional		$234.42	$234.42	$524.81
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $100.00 / $229.09	Professional	26	$100.00	$100.00	$229.09
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $23.44 / $112.20	Professional	TC	$23.44	$23.44	$112.20
United Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $97.72 / $234.42	Professional		$60.26	$97.72	$234.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $63.10 / $158.49	Professional	26	$38.90	$63.10	$158.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $33.11 / $74.13	Professional	TC	$20.89	$33.11	$74.13