Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $158.53 / $270.45 / $473.47	Facility		$158.53	$270.45	$473.47
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 $35.59 / $313.52 / $442.26	Facility	TC	$35.59	$313.52	$442.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $56.68 / $200.42	Professional		$19.95	$56.68	$200.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.35 / $16.35 / $83.09	Professional	26	$7.35	$16.35	$83.09
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $112.62 / $312.74 / $312.74	Professional	50	$112.62	$312.74	$312.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.94 / $35.59 / $119.70	Professional	TC	$19.94	$35.59	$119.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.53 / $62.19 / $171.59	Professional		$28.53	$62.19	$171.59
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 $42.89 / $101.62 / $288.33	Professional	50	$42.89	$101.62	$288.33
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.47 / $46.93 / $129.66	Professional	TC	$20.47	$46.93	$129.66
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.01 / $27.64 / $38.84	Facility		$8.01	$27.64	$38.84
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.53 / $27.73 / $42.68	Professional		$8.53	$27.73	$42.68
Cigna Facility/Professional Facility Modifier Low / Median / High Price $85.61 / $100.04 / $132.96	Facility		$85.61	$100.04	$132.96
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 $65.78 / $76.87 / $102.17	Facility	TC	$65.78	$76.87	$102.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.06 / $110.70 / $125.80	Professional		$32.06	$110.70	$125.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.52 / $27.05 / $30.74	Professional	26	$9.52	$27.05	$30.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.32 / $83.66 / $95.06	Professional	TC	$23.32	$83.66	$95.06
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $27.29 / $46.08 / $65.06	Facility		$27.29	$46.08	$65.06
Medica Facility/Professional Facility Modifier Low / Median / High Price $27.40 / $55.30 / $225.13	Facility		$27.40	$55.30	$225.13
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $135.00	Facility	26	$100.00	$100.00	$135.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $109.00 / $227.23 / $437.52	Facility	TC	$109.00	$227.23	$437.52
Medica Facility/Professional Professional Modifier Low / Median / High Price $31.91 / $76.68 / $202.34	Professional		$31.91	$76.68	$202.34
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.07 / $21.71 / $75.00	Professional	26	$9.07	$21.71	$75.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $22.74 / $53.37 / $163.00	Professional	TC	$22.74	$53.37	$163.00
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 $27.29 / $46.90 / $65.06	Facility		$27.29	$46.90	$65.06
Quartz Facility/Professional Professional Modifier Low / Median / High Price $61.75 / $92.51 / $129.37	Professional		$61.75	$92.51	$129.37
Quartz Facility/Professional Facility Modifier Low / Median / High Price $75.20 / $972.00 / $972.00	Facility		$75.20	$972.00	$972.00
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 / $109.00 / $109.00	Facility	TC	$100.00	$109.00	$109.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $48.96 / $146.50 / $202.34	Professional		$48.96	$146.50	$202.34
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $12.53 / $39.75 / $75.00	Professional	26	$12.53	$39.75	$75.00
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $35.22 / $106.75 / $163.00	Professional	TC	$35.22	$106.75	$163.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $61.54 / $178.87 / $197.19	Professional		$61.54	$178.87	$197.19
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.47 / $23.37 / $47.48	Professional	26	$18.47	$23.37	$47.48
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.07 / $51.59 / $110.02	Professional	TC	$43.07	$51.59	$110.02
United Facility/Professional Professional Modifier Low / Median / High Price $31.04 / $64.93 / $128.41	Professional		$31.04	$64.93	$128.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.69 / $18.30 / $34.84	Professional	26	$8.69	$18.30	$34.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.70 / $46.75 / $91.22	Professional	TC	$22.70	$46.75	$91.22