Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
CareSource Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $66.07 / $93.33	Professional		$26.92	$66.07	$93.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $64.57 / $102.33	Facility	26	$54.95	$64.57	$102.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $269.15 / $309.03	Professional		$89.13	$269.15	$309.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $74.13 / $83.18	Professional	26	$23.99	$74.13	$83.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $194.98 / $223.87	Professional	TC	$64.57	$194.98	$223.87
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $165.96 / $213.80	Professional		$141.25	$165.96	$213.80
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $45.71 / $57.54	Professional	26	$38.90	$45.71	$57.54
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $120.23 / $154.88	Professional	TC	$102.33	$120.23	$154.88
Medica Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $173.78 / $467.74	Professional		$87.10	$173.78	$467.74
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $40.74 / $125.89	Professional	26	$22.39	$40.74	$125.89
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $131.83 / $338.84	Professional	TC	$63.10	$131.83	$338.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $85.11	Professional		$32.36	$33.11	$85.11
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $38.90 / $125.89	Facility	26	$38.90	$38.90	$125.89
Quartz Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $467.74 / $467.74	Professional		$363.08	$467.74	$467.74
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $125.89 / $125.89	Professional	26	$102.33	$125.89	$125.89
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $338.84 / $338.84	Professional	TC	$263.03	$338.84	$338.84
United Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $151.36 / $331.13	Professional		$81.28	$151.36	$331.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $38.90 / $89.13	Professional	26	$22.39	$38.90	$89.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $109.65 / $245.47	Professional	TC	$57.54	$109.65	$245.47