Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $61.78 / $345.27 / $662.02	Facility		$61.78	$345.27	$662.02
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.51 / $16.21 / $22.52	Facility	26	$11.51	$16.21	$22.52
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $45.57 / $396.15 / $482.60	Facility	TC	$45.57	$396.15	$482.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.95 / $61.78 / $230.16	Professional		$35.95	$61.78	$230.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.01 / $16.21 / $89.25	Professional	26	$10.01	$16.21	$89.25
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.29 / $38.29 / $38.29	Professional	50	$38.29	$38.29	$38.29
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $38.29 / $148.75 / $163.63	Professional	52	$38.29	$148.75	$163.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.24 / $40.67 / $99.79	Professional	TC	$26.24	$40.67	$99.79
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.89 / $86.39 / $249.78	Professional		$37.89	$86.39	$249.78
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.46 / $24.16 / $70.18	Professional	26	$10.46	$24.16	$70.18
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $56.20 / $133.09 / $377.08	Professional	50	$56.20	$133.09	$377.08
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $62.76 / $174.90	Professional	TC	$27.54	$62.76	$174.90
CareSource Facility/Professional Facility Modifier Low / Median / High Price $11.11 / $35.29 / $50.50	Facility		$11.11	$35.29	$50.50
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.95 / $35.49 / $55.88	Professional		$11.95	$35.49	$55.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $111.74 / $130.58 / $173.55	Facility		$111.74	$130.58	$173.55
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 $83.80 / $97.93 / $130.16	Facility	TC	$83.80	$97.93	$130.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.59 / $145.00 / $164.78	Professional		$44.59	$145.00	$164.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.00 / $37.90 / $43.08	Professional	26	$13.00	$37.90	$43.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.59 / $107.10 / $121.70	Professional	TC	$31.59	$107.10	$121.70
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $35.31 / $45.95 / $80.94	Facility		$35.31	$45.95	$80.94
Medica Facility/Professional Facility Modifier Low / Median / High Price $35.31 / $61.78 / $321.75	Facility		$35.31	$61.78	$321.75
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $70.00 / $70.00 / $70.00	Facility	26	$70.00	$70.00	$70.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $139.28 / $310.62 / $440.08	Facility	TC	$139.28	$310.62	$440.08
Medica Facility/Professional Professional Modifier Low / Median / High Price $42.17 / $95.78 / $265.10	Professional		$42.17	$95.78	$265.10
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $12.54 / $28.36 / $68.20	Professional	26	$12.54	$28.36	$68.20
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $29.91 / $70.64 / $196.89	Professional	TC	$29.91	$70.64	$196.89
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 $35.31 / $49.01 / $80.94	Facility		$35.31	$49.01	$80.94
Quartz Facility/Professional Professional Modifier Low / Median / High Price $53.39 / $97.81 / $160.90	Professional		$53.39	$97.81	$160.90
Quartz Facility/Professional Facility Modifier Low / Median / High Price $98.50 / $342.77 / $342.77	Facility		$98.50	$342.77	$342.77
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $25.75 / $70.00 / $70.00	Facility	26	$25.75	$70.00	$70.00
Quartz Facility/Professional Facility Modifier TC Low / Median / High Price $72.75 / $139.28 / $139.28	Facility	TC	$72.75	$139.28	$139.28
Quartz Facility/Professional Professional Modifier Low / Median / High Price $61.07 / $191.55 / $265.10	Professional		$61.07	$191.55	$265.10
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $16.52 / $55.70 / $68.20	Professional	26	$16.52	$55.70	$68.20
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $45.10 / $135.85 / $196.89	Professional	TC	$45.10	$135.85	$196.89
Security Health Facility/Professional Professional Modifier Low / Median / High Price $76.84 / $258.39 / $258.39	Professional		$76.84	$258.39	$258.39
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.71 / $25.54 / $51.02	Professional	26	$21.71	$25.54	$51.02
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.87 / $59.85 / $136.33	Professional	TC	$50.87	$59.85	$136.33
United Facility/Professional Professional Modifier Low / Median / High Price $41.03 / $95.78 / $167.89	Professional		$41.03	$95.78	$167.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.15 / $25.22 / $48.82	Professional	26	$12.15	$25.22	$48.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.87 / $63.51 / $119.07	Professional	TC	$28.87	$63.51	$119.07