Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $258.70 / $991.86 / $1,533.54	Facility		$258.70	$991.86	$1,533.54
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.72 / $39.72 / $136.13	Facility	26	$39.72	$39.72	$136.13
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $218.98 / $739.04 / $1,138.33	Facility	TC	$218.98	$739.04	$1,138.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.83 / $270.33 / $889.35	Professional		$199.83	$270.33	$889.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.05 / $44.05 / $242.25	Professional	26	$30.05	$44.05	$242.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.77 / $218.98 / $458.99	Professional	TC	$169.77	$218.98	$458.99
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $230.99 / $427.04 / $1,490.03	Professional		$230.99	$427.04	$1,490.03
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.39 / $65.91 / $231.85	Professional	26	$37.39	$65.91	$231.85
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $195.51 / $362.85 / $1,258.18	Professional	TC	$195.51	$362.85	$1,258.18
CareSource Facility/Professional Facility Modifier Low / Median / High Price $38.45 / $211.76 / $313.57	Facility		$38.45	$211.76	$313.57
CareSource Facility/Professional Professional Modifier Low / Median / High Price $37.38 / $211.76 / $285.30	Professional		$37.38	$211.76	$285.30
Cigna Facility/Professional Facility Modifier Low / Median / High Price $656.92 / $767.66 / $1,177.60	Facility		$656.92	$767.66	$1,177.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.42 / $112.67 / $172.85	Facility	26	$96.42	$112.67	$172.85
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $560.50 / $654.98 / $1,004.76	Facility	TC	$560.50	$654.98	$1,004.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.20 / $607.72 / $690.59	Professional		$263.20	$607.72	$690.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $93.20 / $105.91	Professional	26	$40.74	$93.20	$105.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $221.17 / $514.51 / $584.67	Professional	TC	$221.17	$514.51	$584.67
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $216.17 / $284.00 / $545.63	Facility		$216.17	$284.00	$545.63
Medica Facility/Professional Facility Modifier Low / Median / High Price $215.78 / $314.49 / $1,071.77	Facility		$215.78	$314.49	$1,071.77
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $205.00 / $205.00 / $205.00	Facility	26	$205.00	$205.00	$205.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $807.26 / $906.68 / $906.68	Facility	TC	$807.26	$906.68	$906.68
Medica Facility/Professional Professional Modifier Low / Median / High Price $297.57 / $507.15 / $1,952.19	Professional		$297.57	$507.15	$1,952.19
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $40.06 / $80.05 / $399.57	Professional	26	$40.06	$80.05	$399.57
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $259.93 / $440.63 / $1,791.16	Professional	TC	$259.93	$440.63	$1,791.16
Molina Facility/Professional Professional Modifier Low / Median / High Price $57.73 / $221.57 / $454.36	Professional		$57.73	$221.57	$454.36
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $216.17 / $284.00 / $545.63	Facility		$216.17	$284.00	$545.63
Quartz Facility/Professional Professional Modifier Low / Median / High Price $441.86 / $560.74 / $804.00	Professional		$441.86	$560.74	$804.00
Quartz Facility/Professional Facility Modifier Low / Median / High Price $571.35 / $1,071.77 / $1,071.77	Facility		$571.35	$1,071.77	$1,071.77
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $205.00 / $205.00	Facility	26	$100.00	$205.00	$205.00
Quartz Facility/Professional Facility Modifier TC Low / Median / High Price $483.73 / $906.68 / $906.68	Facility	TC	$483.73	$906.68	$906.68
Quartz Facility/Professional Professional Modifier Low / Median / High Price $274.24 / $1,225.00 / $1,952.19	Professional		$274.24	$1,225.00	$1,952.19
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $42.06 / $190.65 / $399.57	Professional	26	$42.06	$190.65	$399.57
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $232.19 / $1,034.34 / $1,791.16	Professional	TC	$232.19	$1,034.34	$1,791.16
Security Health Facility/Professional Professional Modifier Low / Median / High Price $410.60 / $1,227.46 / $1,227.46	Professional		$410.60	$1,227.46	$1,227.46
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $98.43 / $123.65	Professional	26	$97.72	$98.43	$123.65
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $295.29 / $538.24 / $681.04	Professional	TC	$295.29	$538.24	$681.04
United Facility/Professional Professional Modifier Low / Median / High Price $294.00 / $499.23 / $945.92	Professional		$294.00	$499.23	$945.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.06 / $70.54 / $142.99	Professional	26	$40.06	$70.54	$142.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $250.72 / $430.46 / $803.20	Professional	TC	$250.72	$430.46	$803.20