Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $78.87 / $116.03 / $693.87	Professional		$78.87	$116.03	$693.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.19 / $57.15 / $455.08	Professional	26	$26.19	$57.15	$455.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.68 / $75.84 / $425.93	Professional	TC	$52.68	$75.84	$425.93
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.64 / $283.45 / $589.84	Professional		$44.64	$283.45	$589.84
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.34 / $101.34 / $207.00	Professional	26	$16.34	$101.34	$207.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.66 / $185.76 / $382.84	Professional	TC	$29.66	$185.76	$382.84
CareSource Facility/Professional Facility Modifier Low / Median / High Price $32.04 / $72.84 / $125.87	Facility		$32.04	$72.84	$125.87
CareSource Facility/Professional Professional Modifier Low / Median / High Price $32.04 / $72.89 / $125.87	Professional		$32.04	$72.89	$125.87
Cigna Facility/Professional Facility Modifier Low / Median / High Price $339.08 / $385.31 / $546.91	Facility		$339.08	$385.31	$546.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $106.36 / $120.86 / $171.55	Facility	26	$106.36	$120.86	$171.55
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $232.72 / $264.45 / $375.37	Facility	TC	$232.72	$264.45	$375.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.44 / $154.68 / $339.06	Professional		$52.44	$154.68	$339.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.69 / $46.66 / $109.71	Professional	26	$16.69	$46.66	$109.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.25 / $105.86 / $221.00	Professional	TC	$33.25	$105.86	$221.00
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $73.50 / $116.03 / $314.67	Facility		$73.50	$116.03	$314.67
Medica Facility/Professional Facility Modifier Low / Median / High Price $73.50 / $125.87 / $314.67	Facility		$73.50	$125.87	$314.67
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $170.73 / $170.73 / $170.73	Facility	26	$170.73	$170.73	$170.73
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $357.27 / $357.27 / $357.27	Facility	TC	$357.27	$357.27	$357.27
Medica Facility/Professional Professional Modifier Low / Median / High Price $82.05 / $170.56 / $661.34	Professional		$82.05	$170.56	$661.34
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $33.95 / $116.58 / $278.39	Professional	26	$33.95	$116.58	$278.39
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $51.57 / $116.66 / $424.71	Professional	TC	$51.57	$116.66	$424.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.43 / $65.00 / $210.50	Professional		$36.43	$65.00	$210.50
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $73.50 / $116.03 / $314.67	Facility		$73.50	$116.03	$314.67
Quartz Facility/Professional Professional Modifier Low / Median / High Price $87.89 / $259.93 / $378.01	Professional		$87.89	$259.93	$378.01
Quartz Facility/Professional Facility Modifier Low / Median / High Price $203.78 / $203.78 / $510.17	Facility		$203.78	$203.78	$510.17
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $170.73	Facility	26	$100.00	$100.00	$170.73
Quartz Facility/Professional Facility Modifier TC Low / Median / High Price $137.84 / $137.84 / $357.27	Facility	TC	$137.84	$137.84	$357.27
Quartz Facility/Professional Professional Modifier Low / Median / High Price $53.33 / $512.79 / $661.34	Professional		$53.33	$512.79	$661.34
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $17.80 / $203.99 / $278.39	Professional	26	$17.80	$203.99	$278.39
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $34.46 / $332.80 / $424.71	Professional	TC	$34.46	$332.80	$424.71
Security Health Facility/Professional Professional Modifier Low / Median / High Price $90.64 / $293.20 / $547.20	Professional		$90.64	$293.20	$547.20
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.61 / $34.61 / $130.21	Professional	26	$34.61	$34.61	$130.21
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.53 / $52.53 / $242.18	Professional	TC	$52.53	$52.53	$242.18
United Facility/Professional Professional Modifier Low / Median / High Price $75.94 / $102.56 / $333.32	Professional		$75.94	$102.56	$333.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.93 / $39.29 / $110.80	Professional	26	$24.93	$39.29	$110.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.93 / $66.56 / $200.54	Professional	TC	$47.93	$66.56	$200.54