Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $173.80 / $299.60 / $477.66	Facility		$173.80	$299.60	$477.66
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.93 / $14.47 / $17.48	Facility	26	$8.93	$14.47	$17.48
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $36.09 / $265.98 / $444.40	Facility	TC	$36.09	$265.98	$444.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.59 / $48.68 / $252.80	Professional		$12.59	$48.68	$252.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $15.10 / $80.75	Professional	26	$7.94	$15.10	$80.75
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $20.50 / $39.06 / $188.16	Professional	50	$20.50	$39.06	$188.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.40 / $36.09 / $149.44	Professional	TC	$22.40	$36.09	$149.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.89 / $65.98 / $194.60	Professional		$29.89	$65.98	$194.60
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.11 / $18.76 / $52.25	Professional	26	$8.11	$18.76	$52.25
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $44.28 / $103.92 / $292.38	Professional	50	$44.28	$103.92	$292.38
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.30 / $47.27 / $137.07	Professional	TC	$21.30	$47.27	$137.07
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.69 / $28.02 / $39.90	Facility		$8.69	$28.02	$39.90
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.28 / $28.12 / $44.06	Professional		$9.28	$28.12	$44.06
Cigna Facility/Professional Facility Modifier Low / Median / High Price $89.21 / $104.25 / $138.56	Facility		$89.21	$104.25	$138.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.63 / $25.27 / $33.59	Facility	26	$21.63	$25.27	$33.59
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $67.58 / $78.98 / $104.97	Facility	TC	$67.58	$78.98	$104.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.10 / $115.41 / $131.15	Professional		$36.10	$115.41	$131.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.52 / $29.44 / $33.45	Professional	26	$9.52	$29.44	$33.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.12 / $86.01 / $97.74	Professional	TC	$26.12	$86.01	$97.74
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $28.29 / $48.60 / $67.14	Facility		$28.29	$48.60	$67.14
Medica Facility/Professional Facility Modifier Low / Median / High Price $28.29 / $56.09 / $324.87	Facility		$28.29	$56.09	$324.87
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 $110.49 / $252.26 / $450.30	Facility	TC	$110.49	$252.26	$450.30
Medica Facility/Professional Professional Modifier Low / Median / High Price $33.72 / $80.38 / $208.83	Professional		$33.72	$80.38	$208.83
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.86 / $23.44 / $74.30	Professional	26	$9.86	$23.44	$74.30
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $23.14 / $56.94 / $176.00	Professional	TC	$23.14	$56.94	$176.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.34 / $34.63 / $76.19	Professional		$19.34	$34.63	$76.19
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $28.29 / $48.68 / $67.14	Facility		$28.29	$48.68	$67.14
Quartz Facility/Professional Professional Modifier Low / Median / High Price $63.70 / $95.43 / $134.69	Professional		$63.70	$95.43	$134.69
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 / $110.49 / $110.49	Facility	TC	$100.00	$110.49	$110.49
Quartz Facility/Professional Professional Modifier Low / Median / High Price $53.48 / $148.30 / $208.83	Professional		$53.48	$148.30	$208.83
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $13.64 / $43.25 / $74.30	Professional	26	$13.64	$43.25	$74.30
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $36.51 / $105.17 / $176.00	Professional	TC	$36.51	$105.17	$176.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $66.91 / $191.32 / $205.66	Professional		$66.91	$191.32	$205.66
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.26 / $24.37 / $47.48	Professional	26	$19.26	$24.37	$47.48
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $47.65 / $51.59 / $143.84	Professional	TC	$47.65	$51.59	$143.84
United Facility/Professional Professional Modifier Low / Median / High Price $31.57 / $63.77 / $129.97	Professional		$31.57	$63.77	$129.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.44 / $19.93 / $37.90	Professional	26	$9.44	$19.93	$37.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.51 / $48.40 / $92.19	Professional	TC	$22.51	$48.40	$92.19