Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $137.59 / $910.40 / $1,140.00	Facility		$137.59	$910.40	$1,140.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.14 / $24.14 / $82.73	Facility	26	$24.14	$24.14	$82.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $119.47 / $162.28 / $872.00	Professional		$119.47	$162.28	$872.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.48 / $29.69 / $135.90	Professional	26	$20.48	$29.69	$135.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $101.41 / $119.51 / $294.26	Professional	TC	$101.41	$119.51	$294.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.75 / $252.38 / $879.12	Professional		$144.75	$252.38	$879.12
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.72 / $39.76 / $141.05	Professional	26	$22.72	$39.76	$141.05
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $119.24 / $212.61 / $736.72	Professional	TC	$119.24	$212.61	$736.72
CareSource Facility/Professional Facility Modifier Low / Median / High Price $23.47 / $127.02 / $187.65	Facility		$23.47	$127.02	$187.65
CareSource Facility/Professional Professional Modifier Low / Median / High Price $22.75 / $127.02 / $171.38	Professional		$22.75	$127.02	$171.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $391.99 / $458.07 / $702.69	Facility		$391.99	$458.07	$702.69
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.57 / $68.45 / $105.00	Facility	26	$58.57	$68.45	$105.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $160.75 / $363.43 / $412.99	Professional		$160.75	$363.43	$412.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.75 / $56.75 / $66.59	Professional	26	$24.75	$56.75	$66.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $137.77 / $306.68 / $348.50	Professional	TC	$137.77	$306.68	$348.50
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $120.56 / $164.68 / $304.64	Facility		$120.56	$164.68	$304.64
Medica Facility/Professional Facility Modifier Low / Median / High Price $119.00 / $182.43 / $599.46	Facility		$119.00	$182.43	$599.46
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $161.00 / $161.00 / $161.00	Facility	26	$161.00	$161.00	$161.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $187.14 / $301.73 / $1,223.39	Professional		$187.14	$301.73	$1,223.39
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $24.90 / $50.05 / $237.75	Professional	26	$24.90	$50.05	$237.75
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $157.47 / $260.06 / $1,114.63	Professional	TC	$157.47	$260.06	$1,114.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $55.25 / $125.92 / $260.88	Professional		$55.25	$125.92	$260.88
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $120.02 / $164.68 / $316.94	Facility		$120.02	$164.68	$316.94
Quartz Facility/Professional Professional Modifier Low / Median / High Price $265.24 / $336.60 / $482.63	Professional		$265.24	$336.60	$482.63
Quartz Facility/Professional Facility Modifier Low / Median / High Price $306.63 / $599.46 / $599.46	Facility		$306.63	$599.46	$599.46
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $161.00 / $161.00	Facility	26	$100.00	$161.00	$161.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $164.00 / $647.40 / $1,223.39	Professional		$164.00	$647.40	$1,223.39
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $25.60 / $117.10 / $237.75	Professional	26	$25.60	$117.10	$237.75
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $138.40 / $530.29 / $1,114.63	Professional	TC	$138.40	$530.29	$1,114.63
Security Health Facility/Professional Professional Modifier Low / Median / High Price $295.29 / $658.75 / $658.75	Professional		$295.29	$658.75	$658.75
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.22 / $59.64 / $75.45	Professional	26	$49.22	$59.64	$75.45
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $246.08 / $312.51 / $395.42	Professional	TC	$246.08	$312.51	$395.42
United Facility/Professional Professional Modifier Low / Median / High Price $173.46 / $285.73 / $542.05	Professional		$173.46	$285.73	$542.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.90 / $45.28 / $87.83	Professional	26	$24.90	$45.28	$87.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $146.58 / $247.00 / $460.58	Professional	TC	$146.58	$247.00	$460.58