Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $58.24 / $200.00 / $416.14	Facility		$58.24	$200.00	$416.14
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.06 / $16.76 / $16.88	Facility	26	$12.06	$16.76	$16.88
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.95 / $53.17 / $350.61	Facility	TC	$19.95	$53.17	$350.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.73 / $50.65 / $225.25	Professional		$27.73	$50.65	$225.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.72 / $18.72 / $96.96	Professional	26	$7.72	$18.72	$96.96
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $126.00 / $126.00 / $126.00	Professional	50	$126.00	$126.00	$126.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.71 / $25.33 / $121.13	Professional	52	$14.71	$25.33	$121.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.22 / $30.98 / $78.87	Professional	TC	$22.22	$30.98	$78.87
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.85 / $66.80 / $184.31	Professional		$30.85	$66.80	$184.31
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 $46.27 / $109.39 / $308.58	Professional	50	$46.27	$109.39	$308.58
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.54 / $50.89 / $140.58	Professional	TC	$22.54	$50.89	$140.58
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.33 / $29.55 / $41.45	Facility		$8.33	$29.55	$41.45
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.90 / $29.67 / $45.36	Professional		$8.90	$29.67	$45.36
Cigna Facility/Professional Facility Modifier Low / Median / High Price $91.91 / $107.41 / $142.76	Facility		$91.91	$107.41	$142.76
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 $71.19 / $83.19 / $110.57	Facility	TC	$71.19	$83.19	$110.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.64 / $118.91 / $135.13	Professional		$32.64	$118.91	$135.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $28.23 / $32.08	Professional	26	$9.77	$28.23	$32.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.63 / $90.68 / $103.05	Professional	TC	$23.63	$90.68	$103.05
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $27.82 / $39.69 / $69.90	Facility		$27.82	$39.69	$69.90
Medica Facility/Professional Facility Modifier Low / Median / High Price $28.15 / $50.65 / $257.60	Facility		$28.15	$50.65	$257.60
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $125.00	Facility	26	$100.00	$100.00	$125.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $116.58 / $187.14 / $366.28	Facility	TC	$116.58	$187.14	$366.28
Medica Facility/Professional Professional Modifier Low / Median / High Price $33.33 / $78.38 / $217.55	Professional		$33.33	$78.38	$217.55
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.46 / $21.56 / $59.45	Professional	26	$9.46	$21.56	$59.45
Medica Facility/Professional Professional Modifier 52 Low / Median / High Price $69.52 / $155.25 / $215.10	Professional	52	$69.52	$155.25	$215.10
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $24.54 / $58.26 / $166.53	Professional	TC	$24.54	$58.26	$166.53
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 $27.82 / $39.78 / $69.90	Facility		$27.82	$39.78	$69.90
Quartz Facility/Professional Professional Modifier Low / Median / High Price $65.65 / $87.40 / $134.62	Professional		$65.65	$87.40	$134.62
Quartz Facility/Professional Facility Modifier Low / Median / High Price $88.40 / $342.77 / $342.77	Facility		$88.40	$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 / $116.58 / $116.58	Facility	TC	$100.00	$116.58	$116.58
Quartz Facility/Professional Professional Modifier Low / Median / High Price $52.90 / $156.75 / $217.55	Professional		$52.90	$156.75	$217.55
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $13.07 / $41.45 / $59.45	Professional	26	$13.07	$41.45	$59.45
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $38.20 / $115.30 / $166.53	Professional	TC	$38.20	$115.30	$166.53
Security Health Facility/Professional Professional Modifier Low / Median / High Price $62.30 / $192.53 / $211.86	Professional		$62.30	$192.53	$211.86
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.47 / $23.37 / $49.55	Professional	26	$18.47	$23.37	$49.55
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.83 / $48.20 / $132.57	Professional	TC	$43.83	$48.20	$132.57
United Facility/Professional Professional Modifier Low / Median / High Price $33.20 / $67.40 / $137.38	Professional		$33.20	$67.40	$137.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.96 / $19.10 / $36.33	Professional	26	$8.96	$19.10	$36.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.54 / $48.47 / $101.06	Professional	TC	$24.54	$48.47	$101.06