Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $269.75 / $462.56	Facility		$53.70	$269.75	$462.56
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.11 / $15.07 / $18.23	Facility	26	$13.11	$15.07	$18.23
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $40.58 / $56.66 / $98.34	Facility	TC	$40.58	$56.66	$98.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.25 / $52.47 / $199.00	Professional		$31.25	$52.47	$199.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.34 / $13.32 / $80.75	Professional	26	$8.34	$13.32	$80.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.87 / $31.08 / $64.93	Professional	TC	$22.87	$31.08	$64.93
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $34.64 / $76.72 / $219.91	Professional		$34.64	$76.72	$219.91
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.46 / $19.54 / $55.08	Professional	26	$8.46	$19.54	$55.08
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $24.60 / $53.53 / $147.85	Professional	TC	$24.60	$53.53	$147.85
CareSource Facility/Professional Facility Modifier Low / Median / High Price $9.03 / $31.46 / $44.21	Facility		$9.03	$31.46	$44.21
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.68 / $31.60 / $48.57	Professional		$9.68	$31.60	$48.57
Cigna Facility/Professional Facility Modifier Low / Median / High Price $97.32 / $113.73 / $151.15	Facility		$97.32	$113.73	$151.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.53 / $26.33 / $34.99	Facility	26	$22.53	$26.33	$34.99
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $74.79 / $87.40 / $116.16	Facility	TC	$74.79	$87.40	$116.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.84 / $126.05 / $143.24	Professional		$39.84	$126.05	$143.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.55 / $30.66 / $34.84	Professional	26	$12.55	$30.66	$34.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.02 / $95.35 / $108.35	Professional	TC	$27.02	$95.35	$108.35
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $31.19 / $53.70 / $74.06	Facility		$31.19	$53.70	$74.06
Medica Facility/Professional Facility Modifier Low / Median / High Price $31.19 / $53.70 / $232.35	Facility		$31.19	$53.70	$232.35
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $124.11 / $124.11 / $427.01	Facility	TC	$124.11	$124.11	$427.01
Medica Facility/Professional Professional Modifier Low / Median / High Price $37.94 / $88.78 / $230.47	Professional		$37.94	$88.78	$230.47
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $11.45 / $27.21 / $77.59	Professional	26	$11.45	$27.21	$77.59
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $26.33 / $62.66 / $214.00	Professional	TC	$26.33	$62.66	$214.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.34 / $35.38 / $75.18	Professional		$19.34	$35.38	$75.18
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $31.19 / $53.70 / $74.06	Facility		$31.19	$53.70	$74.06
Quartz Facility/Professional Professional Modifier Low / Median / High Price $70.20 / $105.17 / $152.41	Professional		$70.20	$105.17	$152.41
Quartz Facility/Professional Facility Modifier Low / Median / High Price $98.24 / $342.77 / $342.77	Facility		$98.24	$342.77	$342.77
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Quartz Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $124.11 / $124.11	Facility	TC	$100.00	$124.11	$124.11
Quartz Facility/Professional Professional Modifier Low / Median / High Price $58.39 / $170.65 / $230.47	Professional		$58.39	$170.65	$230.47
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $14.21 / $50.20 / $77.59	Professional	26	$14.21	$50.20	$77.59
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $42.01 / $120.45 / $214.00	Professional	TC	$42.01	$120.45	$214.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $77.84 / $212.54 / $224.59	Professional		$77.84	$212.54	$224.59
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.90 / $35.29 / $68.69	Professional	26	$27.90	$35.29	$68.69
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.94 / $55.98 / $143.84	Professional	TC	$49.94	$55.98	$143.84
United Facility/Professional Facility Modifier Low / Median / High Price $271.91 / $271.91 / $350.62	Facility		$271.91	$271.91	$350.62
United Facility/Professional Professional Modifier Low / Median / High Price $36.09 / $78.62 / $149.57	Professional		$36.09	$78.62	$149.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $23.56 / $44.05	Professional	26	$10.47	$23.56	$44.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.62 / $51.79 / $105.57	Professional	TC	$25.62	$51.79	$105.57