Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $213.80 / $562.34	Facility		$83.18	$213.80	$562.34
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $52.48 / $64.57	Facility	26	$45.71	$52.48	$64.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $91.20 / $213.80	Professional		$40.74	$91.20	$213.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $47.86 / $190.55	Professional	26	$25.12	$47.86	$190.55
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $95.50 / $177.83 / $363.08	Professional	50	$95.50	$177.83	$363.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.88 / $22.91 / $58.88	Professional	TC	$12.88	$22.91	$58.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $87.10 / $288.40	Professional		$46.77	$87.10	$288.40
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $51.29 / $165.96	Professional	26	$29.51	$51.29	$165.96
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $69.18 / $131.83 / $426.58	Professional	50	$69.18	$131.83	$426.58
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $33.88 / $114.82	Professional	TC	$16.98	$33.88	$114.82
CareSource Facility/Professional Facility Modifier Low / Median / High Price $21.38 / $43.65 / $77.62	Facility		$21.38	$43.65	$77.62
CareSource Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $38.02 / $102.33	Professional		$19.50	$38.02	$102.33
Cigna Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $151.36 / $239.88	Facility		$128.82	$151.36	$239.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $95.50 / $151.36	Facility	26	$81.28	$95.50	$151.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $141.25 / $199.53	Professional		$69.18	$141.25	$199.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $81.28 / $125.89	Professional	26	$39.81	$81.28	$125.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $63.10 / $75.86	Professional	TC	$25.12	$63.10	$75.86
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $117.49 / $660.69	Facility		$45.71	$117.49	$660.69
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $100.00 / $144.54	Professional		$87.10	$100.00	$144.54
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $63.10 / $109.65	Professional	26	$54.95	$63.10	$109.65
DeanCare Facility/Professional Professional Modifier 50 Low / Median / High Price $131.83 / $147.91 / $213.80	Professional	50	$131.83	$147.91	$213.80
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $36.31 / $81.28	Professional	TC	$31.62	$36.31	$81.28
Medica Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $104.71 / $269.15	Facility		$45.71	$104.71	$269.15
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $199.53 / $199.53 / $199.53	Facility	26	$199.53	$199.53	$199.53
Medica Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $134.90 / $660.69	Professional		$61.66	$134.90	$660.69
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $77.62 / $338.84	Professional	26	$37.15	$77.62	$338.84
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $63.10 / $407.38	Professional	TC	$24.55	$63.10	$407.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $117.49	Professional		$32.36	$33.11	$117.49
Quartz Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $123.03 / $239.88	Professional		$63.10	$123.03	$239.88
Quartz Facility/Professional Facility Modifier Low / Median / High Price $158.49 / $338.84 / $338.84	Facility		$158.49	$338.84	$338.84
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $199.53 / $199.53	Facility	26	$100.00	$199.53	$199.53
Quartz Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $389.05 / $676.08	Professional		$69.18	$389.05	$676.08
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $165.96 / $338.84	Professional	26	$39.81	$165.96	$338.84
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $229.09 / $416.87	Professional	TC	$25.12	$229.09	$416.87
Security Health Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $288.40 / $380.19	Professional		$229.09	$288.40	$380.19
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $154.88 / $194.98	Professional	26	$123.03	$154.88	$194.98
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $112.20 / $141.25	Professional	TC	$83.18	$112.20	$141.25
United Facility/Professional Facility Modifier Low / Median / High Price $275.42 / $275.42 / $363.08	Facility		$275.42	$275.42	$363.08
United Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $107.15 / $218.78	Professional		$53.70	$107.15	$218.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $61.66 / $125.89	Professional	26	$32.36	$61.66	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $46.77 / $107.15	Professional	TC	$21.38	$46.77	$107.15