Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $200.00 / $527.04 / $786.72	Facility		$200.00	$527.04	$786.72
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.85 / $67.86 / $68.39	Facility	26	$48.85	$67.86	$68.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.01 / $191.06 / $661.71	Professional		$81.01	$191.06	$661.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.72 / $114.40 / $413.10	Professional	26	$30.72	$114.40	$413.10
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $111.81 / $601.50 / $1,730.00	Professional	50	$111.81	$601.50	$1,730.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.26 / $79.01 / $314.52	Professional	TC	$48.26	$79.01	$314.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $82.49 / $127.86 / $463.07	Professional		$82.49	$127.86	$463.07
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.52 / $51.18 / $176.62	Professional	26	$31.52	$51.18	$176.62
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $123.73 / $229.35 / $694.60	Professional	50	$123.73	$229.35	$694.60
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.97 / $79.01 / $287.79	Professional	TC	$50.97	$79.01	$287.79
CareSource Facility/Professional Facility Modifier Low / Median / High Price $33.77 / $61.50 / $107.80	Facility		$33.77	$61.50	$107.80
CareSource Facility/Professional Professional Modifier Low / Median / High Price $34.59 / $60.68 / $105.28	Professional		$34.59	$60.68	$105.28
Cigna Facility/Professional Facility Modifier Low / Median / High Price $230.69 / $269.58 / $413.54	Facility		$230.69	$269.58	$413.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.71 / $98.98 / $151.85	Facility	26	$84.71	$98.98	$151.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.24 / $298.68 / $339.41	Professional		$106.24	$298.68	$339.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.02 / $113.06 / $128.47	Professional	26	$41.02	$113.06	$128.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $65.23 / $185.63 / $210.94	Professional	TC	$65.23	$185.63	$210.94
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $74.61 / $111.92 / $175.80	Facility		$74.61	$111.92	$175.80
Medica Facility/Professional Facility Modifier Low / Median / High Price $74.61 / $166.22 / $514.16	Facility		$74.61	$166.22	$514.16
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $146.86 / $146.86 / $294.00	Facility	26	$146.86	$146.86	$294.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $92.99 / $180.75 / $546.22	Professional		$92.99	$180.75	$546.22
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $37.29 / $80.62 / $203.94	Professional	26	$37.29	$80.62	$203.94
Medica Facility/Professional Professional Modifier 50 Low / Median / High Price $381.38 / $556.30 / $800.47	Professional	50	$381.38	$556.30	$800.47
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $55.80 / $105.55 / $342.28	Professional	TC	$55.80	$105.55	$342.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $38.69 / $85.31 / $191.69	Professional		$38.69	$85.31	$191.69
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $74.61 / $111.92 / $175.80	Facility		$74.61	$111.92	$175.80
Quartz Facility/Professional Professional Modifier Low / Median / High Price $158.52 / $200.36 / $361.16	Professional		$158.52	$200.36	$361.16
Quartz Facility/Professional Facility Modifier Low / Median / High Price $202.90 / $514.16 / $514.16	Facility		$202.90	$514.16	$514.16
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $76.80 / $146.86 / $146.86	Facility	26	$76.80	$146.86	$146.86
Quartz Facility/Professional Professional Modifier Low / Median / High Price $125.81 / $407.83 / $546.22	Professional		$125.81	$407.83	$546.22
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $47.62 / $167.25 / $203.94	Professional	26	$47.62	$167.25	$203.94
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $78.19 / $257.45 / $342.28	Professional	TC	$78.19	$257.45	$342.28
Security Health Facility/Professional Professional Modifier Low / Median / High Price $214.57 / $532.25 / $532.25	Professional		$214.57	$532.25	$532.25
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.64 / $98.40 / $124.51	Professional	26	$83.64	$98.40	$124.51
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $130.93 / $154.03 / $194.89	Professional	TC	$130.93	$154.03	$194.89
United Facility/Professional Facility Modifier Low / Median / High Price $104.04 / $104.04 / $104.04	Facility		$104.04	$104.04	$104.04
United Facility/Professional Professional Modifier Low / Median / High Price $89.62 / $166.99 / $344.01	Professional		$89.62	$166.99	$344.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.32 / $66.48 / $146.60	Professional	26	$36.32	$66.48	$146.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.49 / $104.52 / $225.65	Professional	TC	$54.49	$104.52	$225.65