Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $88.50 / $313.52 / $653.79	Facility		$88.50	$313.52	$653.79
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.93 / $17.48 / $562.59	Facility	26	$8.93	$17.48	$562.59
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $58.05 / $318.25 / $502.90	Facility	TC	$58.05	$318.25	$502.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.19 / $58.90 / $261.00	Professional		$18.19	$58.90	$261.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.02 / $21.96 / $80.00	Professional	26	$8.02	$21.96	$80.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $39.78 / $285.43 / $590.00	Professional	50	$39.78	$285.43	$590.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $16.01 / $19.44 / $36.83	Professional	52	$16.01	$19.44	$36.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.87 / $48.42 / $184.96	Professional	TC	$24.87	$48.42	$184.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.92 / $72.76 / $198.94	Professional		$32.92	$72.76	$198.94
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 $49.32 / $118.33 / $328.98	Professional	50	$49.32	$118.33	$328.98
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.83 / $54.03 / $153.30	Professional	TC	$23.83	$54.03	$153.30
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.69 / $32.22 / $44.70	Facility		$8.69	$32.22	$44.70
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.28 / $32.38 / $48.98	Professional		$9.28	$32.38	$48.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $99.12 / $115.83 / $153.94	Facility		$99.12	$115.83	$153.94
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 $77.50 / $90.56 / $120.36	Facility	TC	$77.50	$90.56	$120.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.44 / $128.33 / $145.83	Professional		$34.44	$128.33	$145.83
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 $25.82 / $98.89 / $112.38	Professional	TC	$25.82	$98.89	$112.38
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $30.95 / $48.23 / $76.13	Facility		$30.95	$48.23	$76.13
Medica Facility/Professional Facility Modifier Low / Median / High Price $32.02 / $122.05 / $342.77	Facility		$32.02	$122.05	$342.77
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $162.75	Facility	26	$100.00	$100.00	$162.75
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $121.91 / $261.24 / $418.69	Facility	TC	$121.91	$261.24	$418.69
Medica Facility/Professional Professional Modifier Low / Median / High Price $36.52 / $90.57 / $237.03	Professional		$36.52	$90.57	$237.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.19 / $28.25 / $77.14	Professional	26	$10.19	$28.25	$77.14
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $26.35 / $64.40 / $183.85	Professional	TC	$26.35	$64.40	$183.85
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 $30.95 / $48.23 / $76.13	Facility		$30.95	$48.23	$76.13
Quartz Facility/Professional Professional Modifier Low / Median / High Price $70.84 / $106.14 / $134.69	Professional		$70.84	$106.14	$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 / $127.16 / $127.16	Facility	TC	$100.00	$127.16	$127.16
Quartz Facility/Professional Professional Modifier Low / Median / High Price $56.04 / $167.10 / $237.03	Professional		$56.04	$167.10	$237.03
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $13.64 / $43.25 / $71.00	Professional	26	$13.64	$43.25	$71.00
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $41.65 / $123.90 / $183.85	Professional	TC	$41.65	$123.90	$183.85
Security Health Facility/Professional Professional Modifier Low / Median / High Price $67.68 / $208.28 / $228.66	Professional		$67.68	$208.28	$228.66
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 $48.41 / $57.35 / $143.84	Professional	TC	$48.41	$57.35	$143.84
United Facility/Professional Facility Modifier Low / Median / High Price $41.30 / $41.30 / $104.04	Facility		$41.30	$41.30	$104.04
United Facility/Professional Professional Modifier Low / Median / High Price $35.36 / $73.62 / $146.46	Professional		$35.36	$73.62	$146.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.02 / $19.80 / $37.90	Professional	26	$9.02	$19.80	$37.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.35 / $53.18 / $108.55	Professional	TC	$26.35	$53.18	$108.55