Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $60.89 / $255.36 / $448.33	Facility		$60.89	$255.36	$448.33
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.56 / $16.07 / $413.25	Facility	26	$11.56	$16.07	$413.25
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $32.10 / $181.45 / $346.46	Facility	TC	$32.10	$181.45	$346.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.77 / $43.66 / $196.24	Professional		$19.77	$43.66	$196.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.14 / $16.35 / $70.70	Professional	26	$7.14	$16.35	$70.70
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $15.32 / $15.32 / $15.32	Professional	50	$15.32	$15.32	$15.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.48 / $29.82 / $90.72	Professional	TC	$18.48	$29.82	$90.72
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.59 / $57.58 / $160.11	Professional		$27.59	$57.58	$160.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.46 / $17.23 / $48.00	Professional	26	$7.46	$17.23	$48.00
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $40.57 / $93.87 / $267.67	Professional	50	$40.57	$93.87	$267.67
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.12 / $42.34 / $116.95	Professional	TC	$19.12	$42.34	$116.95
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.01 / $24.95 / $35.86	Facility		$8.01	$24.95	$35.86
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.53 / $25.01 / $39.56	Professional		$8.53	$25.01	$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 $19.82 / $23.17 / $30.79	Facility	26	$19.82	$23.17	$30.79
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $59.47 / $69.50 / $92.37	Facility	TC	$59.47	$69.50	$92.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.93 / $102.49 / $116.46	Professional		$30.93	$102.49	$116.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.81 / $27.05 / $30.74	Professional	26	$8.81	$27.05	$30.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.21 / $75.44 / $85.73	Professional	TC	$22.21	$75.44	$85.73
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $25.40 / $41.60 / $60.21	Facility		$25.40	$41.60	$60.21
Medica Facility/Professional Facility Modifier Low / Median / High Price $25.40 / $52.76 / $257.50	Facility		$25.40	$52.76	$257.50
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $137.00	Facility	26	$100.00	$100.00	$137.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $250.00 / $479.18	Facility	TC	$100.00	$250.00	$479.18
Medica Facility/Professional Professional Modifier Low / Median / High Price $29.97 / $71.73 / $187.12	Professional		$29.97	$71.73	$187.12
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.44 / $21.90 / $64.39	Professional	26	$9.44	$21.90	$64.39
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $21.04 / $50.15 / $161.00	Professional	TC	$21.04	$50.15	$161.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.34 / $33.89 / $74.33	Professional		$19.34	$33.89	$74.33
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $25.40 / $41.60 / $60.21	Facility		$25.40	$41.60	$60.21
Quartz Facility/Professional Professional Modifier Low / Median / High Price $57.20 / $85.69 / $123.93	Professional		$57.20	$85.69	$123.93
Quartz Facility/Professional Facility Modifier Low / Median / High Price $77.16 / $342.77 / $342.77	Facility		$77.16	$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 $46.13 / $137.90 / $187.12	Professional		$46.13	$137.90	$187.12
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $12.53 / $41.45 / $64.39	Professional	26	$12.53	$41.45	$64.39
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $33.19 / $96.50 / $161.00	Professional	TC	$33.19	$96.50	$161.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $55.44 / $165.20 / $182.59	Professional		$55.44	$165.20	$182.59
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.47 / $23.37 / $45.53	Professional	26	$18.47	$23.37	$45.53
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.97 / $45.52 / $113.78	Professional	TC	$36.97	$45.52	$113.78
United Facility/Professional Facility Modifier Low / Median / High Price $104.04 / $104.04 / $104.04	Facility		$104.04	$104.04	$104.04
United Facility/Professional Professional Modifier Low / Median / High Price $49.83 / $95.00 / $212.23	Professional		$49.83	$95.00	$212.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.93 / $18.98 / $36.33	Professional	26	$8.93	$18.98	$36.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.57 / $42.89 / $84.54	Professional	TC	$20.57	$42.89	$84.54