Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $58.79 / $317.80 / $498.61	Facility		$58.79	$317.80	$498.61
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.06 / $12.71 / $15.37	Facility	26	$11.06	$12.71	$15.37
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $31.10 / $43.43 / $349.46	Facility	TC	$31.10	$43.43	$349.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.22 / $52.25 / $218.22	Professional		$27.22	$52.25	$218.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.09 / $15.37 / $89.30	Professional	26	$7.09	$15.37	$89.30
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $54.54 / $351.12 / $500.00	Professional	50	$54.54	$351.12	$500.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.27 / $21.09 / $106.25	Professional	52	$12.27	$21.09	$106.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.92 / $25.55 / $44.67	Professional	TC	$17.92	$25.55	$44.67
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.54 / $55.62 / $160.11	Professional		$26.54	$55.62	$160.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.14 / $16.48 / $45.94	Professional	26	$7.14	$16.48	$45.94
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $39.03 / $91.65 / $258.39	Professional	50	$39.03	$91.65	$258.39
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.76 / $41.02 / $115.13	Professional	TC	$18.76	$41.02	$115.13
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.68 / $24.18 / $34.68	Facility		$7.68	$24.18	$34.68
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.18 / $24.25 / $38.21	Professional		$8.18	$24.25	$38.21
Cigna Facility/Professional Facility Modifier Low / Median / High Price $77.50 / $90.56 / $120.36	Facility		$77.50	$90.56	$120.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.92 / $22.11 / $29.39	Facility	26	$18.92	$22.11	$29.39
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $58.57 / $68.45 / $90.97	Facility	TC	$58.57	$68.45	$90.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.31 / $100.13 / $113.79	Professional		$30.31	$100.13	$113.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.11 / $25.87 / $29.40	Professional	26	$9.11	$25.87	$29.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.06 / $74.26 / $84.39	Professional	TC	$21.06	$74.26	$84.39
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $24.54 / $42.17 / $58.14	Facility		$24.54	$42.17	$58.14
Medica Facility/Professional Facility Modifier Low / Median / High Price $24.54 / $42.17 / $238.18	Facility		$24.54	$42.17	$238.18
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 $92.81 / $129.68 / $356.59	Facility	TC	$92.81	$129.68	$356.59
Medica Facility/Professional Professional Modifier Low / Median / High Price $29.15 / $67.30 / $180.63	Professional		$29.15	$67.30	$180.63
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.69 / $19.77 / $67.70	Professional	26	$8.69	$19.77	$67.70
Medica Facility/Professional Professional Modifier 52 Low / Median / High Price $43.71 / $43.71 / $152.55	Professional	52	$43.71	$43.71	$152.55
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $20.72 / $49.32 / $154.00	Professional	TC	$20.72	$49.32	$154.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.34 / $33.89 / $70.00	Professional		$19.34	$33.89	$70.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $24.54 / $42.17 / $58.14	Facility		$24.54	$42.17	$58.14
Quartz Facility/Professional Professional Modifier Low / Median / High Price $55.25 / $82.77 / $111.78	Professional		$55.25	$82.77	$111.78
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 $45.58 / $132.80 / $180.63	Professional		$45.58	$132.80	$180.63
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $11.98 / $38.00 / $67.70	Professional	26	$11.98	$38.00	$67.70
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $32.39 / $94.75 / $154.00	Professional	TC	$32.39	$94.75	$154.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $55.44 / $161.29 / $178.39	Professional		$55.44	$161.29	$178.39
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.94 / $21.43 / $41.77	Professional	26	$16.94	$21.43	$41.77
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.50 / $42.90 / $115.66	Professional	TC	$38.50	$42.90	$115.66
United Facility/Professional Professional Modifier Low / Median / High Price $28.15 / $61.19 / $116.54	Professional		$28.15	$61.19	$116.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $17.39 / $33.35	Professional	26	$7.94	$17.39	$33.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.21 / $42.02 / $83.09	Professional	TC	$20.21	$42.02	$83.09