Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $57.88 / $66.56 / $66.56	Facility		$57.88	$66.56	$66.56
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.02 / $28.77 / $28.77	Facility	26	$25.02	$28.77	$28.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.86 / $88.10 / $277.05	Professional		$55.86	$88.10	$277.05
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $81.93 / $81.93 / $81.93	Professional	25	$81.93	$81.93	$81.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.95 / $33.79 / $110.70	Professional	26	$24.95	$33.79	$110.70
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $25.80 / $32.19 / $48.14	Professional	52	$25.80	$32.19	$48.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.94 / $41.00 / $76.80	Professional	TC	$28.94	$41.00	$76.80
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $62.76 / $120.59 / $204.69	Professional		$62.76	$120.59	$204.69
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.80 / $52.13 / $89.31	Professional	26	$27.80	$52.13	$89.31
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $34.96 / $68.45 / $116.07	Professional	TC	$34.96	$68.45	$116.07
CareSource Facility/Professional Facility Modifier Low / Median / High Price $24.68 / $32.65 / $57.35	Facility		$24.68	$32.65	$57.35
CareSource Facility/Professional Professional Modifier Low / Median / High Price $24.68 / $32.65 / $57.35	Professional		$24.68	$32.65	$57.35
Cigna Facility/Professional Facility Modifier Low / Median / High Price $173.02 / $202.18 / $229.75	Facility		$173.02	$202.18	$229.75
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $71.19 / $83.19 / $94.53	Facility	26	$71.19	$83.19	$94.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.22 / $127.63 / $163.86	Professional		$69.22	$127.63	$163.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.20 / $53.86 / $66.15	Professional	26	$29.20	$53.86	$66.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.39 / $73.76 / $92.40	Professional	TC	$40.39	$73.76	$92.40
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $51.41 / $70.56 / $126.42	Facility		$51.41	$70.56	$126.42
Medica Facility/Professional Facility Modifier Low / Median / High Price $49.98 / $70.56 / $182.57	Facility		$49.98	$70.56	$182.57
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $61.29 / $152.15 / $152.15	Facility	26	$61.29	$152.15	$152.15
Medica Facility/Professional Professional Modifier Low / Median / High Price $62.42 / $93.65 / $300.39	Professional		$62.42	$93.65	$300.39
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $24.95 / $35.63 / $108.27	Professional	26	$24.95	$35.63	$108.27
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $33.85 / $49.64 / $139.26	Professional	TC	$33.85	$49.64	$139.26
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.84 / $58.40 / $126.60	Professional		$25.84	$58.40	$126.60
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $51.41 / $70.56 / $126.42	Facility		$51.41	$70.56	$126.42
Quartz Facility/Professional Professional Modifier Low / Median / High Price $78.40 / $144.15 / $204.46	Professional		$78.40	$144.15	$204.46
Quartz Facility/Professional Facility Modifier Low / Median / High Price $127.60 / $129.86 / $286.08	Facility		$127.60	$129.86	$286.08
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $54.14 / $61.29 / $152.15	Facility	26	$54.14	$61.29	$152.15
Quartz Facility/Professional Professional Modifier Low / Median / High Price $111.80 / $307.14 / $396.63	Professional		$111.80	$307.14	$396.63
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $49.89 / $137.05 / $167.21	Professional	26	$49.89	$137.05	$167.21
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $61.92 / $192.85 / $257.11	Professional	TC	$61.92	$192.85	$257.11
Security Health Facility/Professional Professional Modifier Low / Median / High Price $98.70 / $224.00 / $224.00	Professional		$98.70	$224.00	$224.00
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.25 / $64.18 / $88.83	Professional	26	$43.25	$64.18	$88.83
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.98 / $54.86 / $104.50	Professional	TC	$20.98	$54.86	$104.50
United Facility/Professional Professional Modifier Low / Median / High Price $62.57 / $80.30 / $182.45	Professional		$62.57	$80.30	$182.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.95 / $34.26 / $71.50	Professional	26	$24.95	$34.26	$71.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.85 / $46.18 / $86.85	Professional	TC	$33.85	$46.18	$86.85