Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $137.38 / $438.62 / $981.74	Facility		$137.38	$438.62	$981.74
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.48 / $22.48 / $76.67	Facility	26	$22.48	$22.48	$76.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.27 / $187.84 / $665.00	Professional		$120.27	$187.84	$665.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.39 / $25.74 / $113.94	Professional	26	$20.39	$25.74	$113.94
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $59.33 / $68.69 / $216.86	Professional	52	$59.33	$68.69	$216.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.61 / $161.77 / $368.95	Professional	TC	$102.61	$161.77	$368.95
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $129.53 / $223.75 / $774.42	Professional		$129.53	$223.75	$774.42
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.15 / $37.50 / $129.35	Professional	26	$21.15	$37.50	$129.35
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $108.20 / $186.73 / $645.07	Professional	TC	$108.20	$186.73	$645.07
CareSource Facility/Professional Facility Modifier Low / Median / High Price $22.07 / $116.16 / $170.84	Facility		$22.07	$116.16	$170.84
CareSource Facility/Professional Professional Modifier Low / Median / High Price $21.14 / $116.02 / $156.91	Professional		$21.14	$116.02	$156.91
Cigna Facility/Professional Facility Modifier Low / Median / High Price $354.14 / $413.84 / $634.84	Facility		$354.14	$413.84	$634.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.07 / $63.18 / $96.92	Facility	26	$54.07	$63.18	$96.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.06 / $327.95 / $372.68	Professional		$144.06	$327.95	$372.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.88 / $52.60 / $62.02	Professional	26	$24.88	$52.60	$62.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $120.88 / $275.33 / $312.88	Professional	TC	$120.88	$275.33	$312.88
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $122.46 / $171.85 / $365.63	Facility		$122.46	$171.85	$365.63
Medica Facility/Professional Facility Modifier Low / Median / High Price $119.42 / $180.54 / $616.02	Facility		$119.42	$180.54	$616.02
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $176.87 / $176.87 / $176.87	Facility	26	$176.87	$176.87	$176.87
Medica Facility/Professional Professional Modifier Low / Median / High Price $166.21 / $285.39 / $1,173.20	Professional		$166.21	$285.39	$1,173.20
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $25.14 / $45.97 / $310.41	Professional	26	$25.14	$45.97	$310.41
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $138.32 / $243.41 / $1,048.79	Professional	TC	$138.32	$243.41	$1,048.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $58.40 / $148.90 / $221.00	Professional		$58.40	$148.90	$221.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $121.54 / $171.85 / $365.63	Facility		$121.54	$171.85	$365.63
Quartz Facility/Professional Professional Modifier Low / Median / High Price $242.77 / $370.33 / $527.10	Professional		$242.77	$370.33	$527.10
Quartz Facility/Professional Facility Modifier Low / Median / High Price $308.33 / $616.02 / $616.02	Facility		$308.33	$616.02	$616.02
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $176.87 / $176.87	Facility	26	$100.00	$176.87	$176.87
Quartz Facility/Professional Professional Modifier Low / Median / High Price $147.99 / $693.93 / $1,173.20	Professional		$147.99	$693.93	$1,173.20
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $23.74 / $154.19 / $310.41	Professional	26	$23.74	$154.19	$310.41
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $124.25 / $605.38 / $1,048.79	Professional	TC	$124.25	$605.38	$1,048.79
Security Health Facility/Professional Professional Modifier Low / Median / High Price $275.60 / $662.35 / $662.35	Professional		$275.60	$662.35	$662.35
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.10 / $65.00 / $167.33	Professional	26	$55.10	$65.00	$167.33
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $108.27 / $282.12 / $370.40	Professional	TC	$108.27	$282.12	$370.40
United Facility/Professional Professional Modifier Low / Median / High Price $160.71 / $251.82 / $491.65	Professional		$160.71	$251.82	$491.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.95 / $57.78 / $97.13	Professional	26	$31.95	$57.78	$97.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $130.15 / $219.56 / $409.53	Professional	TC	$130.15	$219.56	$409.53