Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $85.60 / $292.02 / $498.00	Facility		$85.60	$292.02	$498.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.15 / $21.83 / $208.17	Facility	26	$11.15	$21.83	$208.17
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $74.53 / $311.74 / $395.72	Facility	TC	$74.53	$311.74	$395.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.17 / $58.02 / $297.50	Professional		$31.17	$58.02	$297.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.88 / $26.40 / $92.65	Professional	26	$9.88	$26.40	$92.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.93 / $33.47 / $192.85	Professional	TC	$19.93	$33.47	$192.85
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $31.21 / $66.34 / $190.28	Professional		$31.21	$66.34	$190.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.14 / $23.42 / $65.25	Professional	26	$10.14	$23.42	$65.25
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.49 / $45.34 / $126.04	Professional	TC	$20.49	$45.34	$126.04
CareSource Facility/Professional Facility Modifier Low / Median / High Price $10.79 / $26.87 / $41.37	Facility		$10.79	$26.87	$41.37
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.59 / $27.90 / $45.59	Professional		$11.59	$27.90	$45.59
Cigna Facility/Professional Facility Modifier Low / Median / High Price $91.01 / $106.36 / $141.36	Facility		$91.01	$106.36	$141.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.03 / $31.59 / $41.99	Facility	26	$27.03	$31.59	$41.99
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $63.98 / $74.77 / $99.37	Facility	TC	$63.98	$74.77	$99.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.51 / $118.02 / $134.11	Professional		$35.51	$118.02	$134.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.36 / $36.72 / $41.74	Professional	26	$12.36	$36.72	$41.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.09 / $81.29 / $92.38	Professional	TC	$23.09	$81.29	$92.38
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $29.29 / $39.90 / $65.68	Facility		$29.29	$39.90	$65.68
Medica Facility/Professional Facility Modifier Low / Median / High Price $36.72 / $201.85 / $330.54	Facility		$36.72	$201.85	$330.54
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $70.00 / $76.95 / $150.94	Facility	26	$70.00	$76.95	$150.94
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $132.24 / $258.93 / $388.87	Facility	TC	$132.24	$258.93	$388.87
Medica Facility/Professional Professional Modifier Low / Median / High Price $35.08 / $87.83 / $285.49	Professional		$35.08	$87.83	$285.49
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $12.96 / $45.67 / $89.68	Professional	26	$12.96	$45.67	$89.68
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $22.58 / $51.90 / $149.15	Professional	TC	$22.58	$51.90	$149.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.34 / $36.36 / $74.33	Professional		$19.34	$36.36	$74.33
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $29.29 / $44.43 / $65.68	Facility		$29.29	$44.43	$65.68
Quartz Facility/Professional Professional Modifier Low / Median / High Price $58.87 / $79.67 / $130.47	Professional		$58.87	$79.67	$130.47
Quartz Facility/Professional Facility Modifier Low / Median / High Price $85.84 / $342.77 / $342.77	Facility		$85.84	$342.77	$342.77
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $24.95 / $70.00 / $70.00	Facility	26	$24.95	$70.00	$70.00
Quartz Facility/Professional Facility Modifier TC Low / Median / High Price $55.23 / $105.96 / $105.96	Facility	TC	$55.23	$105.96	$105.96
Quartz Facility/Professional Professional Modifier Low / Median / High Price $49.71 / $157.30 / $215.20	Professional		$49.71	$157.30	$215.20
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $16.01 / $54.00 / $66.04	Professional	26	$16.01	$54.00	$66.04
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $34.24 / $103.35 / $149.15	Professional	TC	$34.24	$103.35	$149.15
Security Health Facility/Professional Professional Modifier Low / Median / High Price $59.00 / $210.32 / $210.32	Professional		$59.00	$210.32	$210.32
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $24.02 / $36.93	Professional	26	$20.42	$24.02	$36.93
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.32 / $47.73 / $81.73	Professional	TC	$35.32	$47.73	$81.73
United Facility/Professional Professional Modifier Low / Median / High Price $33.20 / $67.64 / $137.87	Professional		$33.20	$67.64	$137.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.55 / $59.93 / $87.90	Professional	26	$18.55	$59.93	$87.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.11 / $95.00 / $159.00	Professional	TC	$38.11	$95.00	$159.00