Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $112.37 / $362.88 / $607.54	Facility		$112.37	$362.88	$607.54
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.51 / $18.64 / $22.52	Facility	26	$11.51	$18.64	$22.52
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $50.11 / $396.15 / $544.25	Facility	TC	$50.11	$396.15	$544.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.11 / $59.79 / $280.50	Professional		$37.11	$59.79	$280.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.19 / $23.97 / $96.72	Professional	26	$10.19	$23.97	$96.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.62 / $47.39 / $204.00	Professional	TC	$26.62	$47.39	$204.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.25 / $78.84 / $217.71	Professional		$36.25	$78.84	$217.71
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.46 / $24.16 / $67.31	Professional	26	$10.46	$24.16	$67.31
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.14 / $55.61 / $158.75	Professional	TC	$25.14	$55.61	$158.75
CareSource Facility/Professional Facility Modifier Low / Median / High Price $11.11 / $33.38 / $48.52	Facility		$11.11	$33.38	$48.52
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.95 / $34.67 / $53.64	Professional		$11.95	$34.67	$53.64
Cigna Facility/Professional Facility Modifier Low / Median / High Price $108.13 / $126.36 / $167.95	Facility		$108.13	$126.36	$167.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.93 / $32.64 / $43.39	Facility	26	$27.93	$32.64	$43.39
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $80.20 / $93.72 / $124.56	Facility	TC	$80.20	$93.72	$124.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.86 / $140.33 / $159.46	Professional		$41.86	$140.33	$159.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.86 / $37.90 / $43.08	Professional	26	$12.86	$37.90	$43.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.96 / $102.42 / $116.39	Professional	TC	$28.96	$102.42	$116.39
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $33.89 / $54.08 / $82.36	Facility		$33.89	$54.08	$82.36
Medica Facility/Professional Facility Modifier Low / Median / High Price $34.74 / $73.48 / $342.77	Facility		$34.74	$73.48	$342.77
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $195.33	Facility	26	$100.00	$100.00	$195.33
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $132.63 / $309.41 / $528.97	Facility	TC	$132.63	$309.41	$528.97
Medica Facility/Professional Professional Modifier Low / Median / High Price $40.72 / $96.69 / $256.38	Professional		$40.72	$96.69	$256.38
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $36.39 / $94.50	Professional	26	$13.18	$36.39	$94.50
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $28.02 / $66.51 / $211.00	Professional	TC	$28.02	$66.51	$211.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.34 / $40.15 / $76.19	Professional		$19.34	$40.15	$76.19
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $33.89 / $56.16 / $82.36	Facility		$33.89	$56.16	$82.36
Quartz Facility/Professional Professional Modifier Low / Median / High Price $77.34 / $115.88 / $198.89	Professional		$77.34	$115.88	$198.89
Quartz Facility/Professional Facility Modifier Low / Median / High Price $95.44 / $342.77 / $342.77	Facility		$95.44	$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 / $131.69 / $131.69	Facility	TC	$100.00	$131.69	$131.69
Quartz Facility/Professional Professional Modifier Low / Median / High Price $66.72 / $183.00 / $256.38	Professional		$66.72	$183.00	$256.38
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $17.55 / $55.70 / $82.56	Professional	26	$17.55	$55.70	$82.56
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $43.13 / $127.30 / $211.00	Professional	TC	$43.13	$127.30	$211.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $75.48 / $226.45 / $249.99	Professional		$75.48	$226.45	$249.99
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $31.35 / $63.17	Professional	26	$24.78	$31.35	$63.17
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.70 / $60.69 / $140.08	Professional	TC	$50.70	$60.69	$140.08
United Facility/Professional Professional Modifier Low / Median / High Price $38.95 / $80.90 / $160.60	Professional		$38.95	$80.90	$160.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.55 / $24.13 / $48.82	Professional	26	$11.55	$24.13	$48.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.07 / $58.30 / $111.58	Professional	TC	$27.07	$58.30	$111.58