Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $245.47 / $1,445.44 / $1,905.46	Facility		$245.47	$1,445.44	$1,905.46
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $40.74 / $229.09	Facility	26	$34.67	$40.74	$229.09
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $190.55 / $933.25 / $1,737.80	Facility	TC	$190.55	$933.25	$1,737.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $295.12 / $912.01	Professional		$173.78	$295.12	$912.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $45.71 / $177.83	Professional	26	$30.20	$45.71	$177.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $177.83 / $426.58	Professional	TC	$138.04	$177.83	$426.58
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $281.84 / $758.58	Professional		$190.55	$281.84	$758.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $50.12 / $134.90	Professional	26	$33.11	$50.12	$134.90
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $223.87 / $616.60	Professional	TC	$154.88	$223.87	$616.60
CareSource Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $204.17 / $288.40	Facility		$43.65	$204.17	$288.40
CareSource Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $169.82 / $263.03	Professional		$33.88	$169.82	$263.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $457.09 / $602.56 / $954.99	Facility		$457.09	$602.56	$954.99
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $100.00 / $158.49	Facility	26	$85.11	$100.00	$158.49
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $426.58 / $501.19 / $794.33	Facility	TC	$426.58	$501.19	$794.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $478.63 / $575.44	Professional		$204.17	$478.63	$575.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $79.43 / $97.72	Professional	26	$35.48	$79.43	$97.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $398.11 / $478.63	Professional	TC	$169.82	$398.11	$478.63
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $165.96 / $234.42 / $407.38	Facility		$165.96	$234.42	$407.38
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $380.19 / $512.86	Professional		$331.13	$380.19	$512.86
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $66.07 / $89.13	Professional	26	$57.54	$66.07	$89.13
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $316.23 / $426.58	Professional	TC	$275.42	$316.23	$426.58
Medica Facility/Professional Facility Modifier Low / Median / High Price $177.83 / $389.05 / $1,479.11	Facility		$177.83	$389.05	$1,479.11
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $645.65	Facility	26	$213.80	$213.80	$645.65
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $524.81 / $912.01 / $1,698.24	Facility	TC	$524.81	$912.01	$1,698.24
Medica Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $380.19 / $1,584.89	Professional		$218.78	$380.19	$1,584.89
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $69.18 / $891.25	Professional	26	$36.31	$69.18	$891.25
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $309.03 / $1,380.38	Professional	TC	$177.83	$309.03	$1,380.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $302.00	Professional		$32.36	$33.11	$302.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $436.52 / $602.56	Professional		$234.42	$436.52	$602.56
Quartz Facility/Professional Facility Modifier Low / Median / High Price $426.58 / $1,230.27 / $1,230.27	Facility		$426.58	$1,230.27	$1,230.27
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $213.80 / $213.80	Facility	26	$100.00	$213.80	$213.80
Quartz Facility/Professional Facility Modifier TC Low / Median / High Price $354.81 / $1,023.29 / $1,023.29	Facility	TC	$354.81	$1,023.29	$1,023.29
Quartz Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $933.25 / $1,621.81	Professional		$204.17	$933.25	$1,621.81
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $165.96 / $891.25	Professional	26	$35.48	$165.96	$891.25
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $776.25 / $1,412.54	Professional	TC	$169.82	$776.25	$1,412.54
Security Health Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $575.44 / $954.99	Professional		$354.81	$575.44	$954.99
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $93.33 / $109.65	Professional	26	$79.43	$93.33	$109.65
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $398.11 / $501.19	Professional	TC	$257.04	$398.11	$501.19
United Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $630.96 / $831.76	Facility		$630.96	$630.96	$831.76
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $302.00 / $616.60	Professional		$199.53	$302.00	$616.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $50.12 / $109.65	Professional	26	$35.48	$50.12	$109.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $245.47 / $512.86	Professional	TC	$162.18	$245.47	$512.86