Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $60.89 / $224.13 / $364.53	Facility		$60.89	$224.13	$364.53
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.06 / $13.86 / $16.76	Facility	26	$12.06	$13.86	$16.76
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $31.60 / $300.20 / $693.35	Facility	TC	$31.60	$300.20	$693.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $20.79 / $43.66 / $163.79	Professional		$20.79	$43.66	$163.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.23 / $16.80 / $67.45	Professional	26	$7.23	$16.80	$67.45
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $116.40 / $116.40 / $117.92	Professional	50	$116.40	$116.40	$117.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.82 / $30.01 / $106.40	Professional	TC	$18.82	$30.01	$106.40
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.52 / $58.76 / $170.21	Professional		$26.52	$58.76	$170.21
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.78 / $17.97 / $50.06	Professional	26	$7.78	$17.97	$50.06
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $39.71 / $93.87 / $267.67	Professional	50	$39.71	$93.87	$267.67
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.70 / $41.39 / $117.05	Professional	TC	$18.70	$41.39	$117.05
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.33 / $24.57 / $35.86	Facility		$8.33	$24.57	$35.86
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.90 / $25.52 / $39.56	Professional		$8.90	$25.52	$39.56
Cigna Facility/Professional Facility Modifier Low / Median / High Price $79.30 / $92.67 / $123.16	Facility		$79.30	$92.67	$123.16
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.73 / $24.22 / $32.19	Facility	26	$20.73	$24.22	$32.19
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $58.57 / $68.45 / $90.97	Facility	TC	$58.57	$68.45	$90.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.05 / $102.49 / $116.46	Professional		$31.05	$102.49	$116.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.74 / $28.23 / $32.08	Professional	26	$8.74	$28.23	$32.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.21 / $74.26 / $84.39	Professional	TC	$22.21	$74.26	$84.39
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $25.13 / $43.29 / $60.21	Facility		$25.13	$43.29	$60.21
Medica Facility/Professional Facility Modifier Low / Median / High Price $25.40 / $44.96 / $244.63	Facility		$25.40	$44.96	$244.63
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 $79.50 / $200.93 / $374.00	Facility	TC	$79.50	$200.93	$374.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $29.99 / $70.81 / $187.12	Professional		$29.99	$70.81	$187.12
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.03 / $21.57 / $67.70	Professional	26	$9.03	$21.57	$67.70
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $20.88 / $49.42 / $160.00	Professional	TC	$20.88	$49.42	$160.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.34 / $33.89 / $70.00	Professional		$19.34	$33.89	$70.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $25.13 / $43.29 / $60.21	Facility		$25.13	$43.29	$60.21
Quartz Facility/Professional Professional Modifier Low / Median / High Price $57.20 / $85.69 / $116.28	Professional		$57.20	$85.69	$116.28
Quartz Facility/Professional Facility Modifier Low / Median / High Price $80.00 / $342.77 / $342.77	Facility		$80.00	$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 / $100.00 / $100.00	Facility	TC	$100.00	$100.00	$100.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $47.48 / $136.19 / $187.12	Professional		$47.48	$136.19	$187.12
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $12.92 / $41.45 / $67.70	Professional	26	$12.92	$41.45	$67.70
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $32.89 / $94.75 / $160.00	Professional	TC	$32.89	$94.75	$160.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $58.45 / $165.20 / $182.59	Professional		$58.45	$165.20	$182.59
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.67 / $22.36 / $43.57	Professional	26	$17.67	$22.36	$43.57
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.78 / $51.60 / $119.43	Professional	TC	$40.78	$51.60	$119.43
United Facility/Professional Facility Modifier Low / Median / High Price $39.20 / $39.20 / $104.04	Facility		$39.20	$39.20	$104.04
United Facility/Professional Professional Modifier Low / Median / High Price $28.87 / $62.38 / $119.38	Professional		$28.87	$62.38	$119.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.03 / $19.48 / $36.33	Professional	26	$9.03	$19.48	$36.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.29 / $45.47 / $83.15	Professional	TC	$20.29	$45.47	$83.15