Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $288.40 / $549.54 / $776.25	Facility		$288.40	$549.54	$776.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $56.23 / $83.18	Facility	26	$34.67	$56.23	$83.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $120.23 / $446.68	Professional		$50.12	$120.23	$446.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $67.61 / $281.84	Professional	26	$30.20	$67.61	$281.84
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $69.18 / $204.17 / $954.99	Professional	50	$69.18	$204.17	$954.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $58.88 / $154.88	Professional	TC	$42.66	$58.88	$154.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $128.82 / $389.05	Professional		$83.18	$128.82	$389.05
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $48.98 / $147.91	Professional	26	$31.62	$48.98	$147.91
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $123.03 / $190.55 / $588.84	Professional	50	$123.03	$190.55	$588.84
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $79.43 / $239.88	Professional	TC	$51.29	$79.43	$239.88
CareSource Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $72.44 / $134.90	Facility		$44.67	$72.44	$134.90
CareSource Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $74.13 / $169.82	Professional		$37.15	$74.13	$169.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $229.09 / $269.15 / $426.58	Facility		$229.09	$269.15	$426.58
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $100.00 / $158.49	Facility	26	$85.11	$100.00	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $199.53 / $346.74	Professional		$91.20	$199.53	$346.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $74.13 / $131.83	Professional	26	$35.48	$74.13	$131.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $125.89 / $213.80	Professional	TC	$54.95	$125.89	$213.80
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $158.49 / $457.09	Facility		$74.13	$158.49	$457.09
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $177.83 / $234.42	Professional		$154.88	$177.83	$234.42
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $67.61 / $89.13	Professional	26	$58.88	$67.61	$89.13
DeanCare Facility/Professional Professional Modifier 50 Low / Median / High Price $229.09 / $263.03 / $354.81	Professional	50	$229.09	$263.03	$354.81
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $109.65 / $147.91	Professional	TC	$95.50	$109.65	$147.91
Medica Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $223.87 / $512.86	Facility		$77.62	$223.87	$512.86
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $147.91 / $147.91 / $295.12	Facility	26	$147.91	$147.91	$295.12
Medica Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $162.18 / $549.54	Professional		$89.13	$162.18	$549.54
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $75.86 / $223.87	Professional	26	$36.31	$75.86	$223.87
Medica Facility/Professional Professional Modifier 50 Low / Median / High Price $380.19 / $562.34 / $794.33	Professional	50	$380.19	$562.34	$794.33
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $95.50 / $338.84	Professional	TC	$54.95	$95.50	$338.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $70.79	Professional		$32.36	$33.11	$70.79
Quartz Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $194.98 / $295.12	Professional		$107.15	$194.98	$295.12
Quartz Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $549.54 / $549.54	Facility		$194.98	$549.54	$549.54
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $204.17 / $204.17	Facility	26	$75.86	$204.17	$204.17
Quartz Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $426.58 / $549.54	Professional		$75.86	$426.58	$549.54
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $165.96 / $204.17	Professional	26	$28.84	$165.96	$204.17
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $257.04 / $338.84	Professional	TC	$48.98	$257.04	$338.84
Security Health Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $302.00 / $537.03	Professional		$213.80	$302.00	$537.03
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $97.72 / $125.89	Professional	26	$83.18	$97.72	$125.89
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $154.88 / $194.98	Professional	TC	$131.83	$154.88	$194.98
United Facility/Professional Facility Modifier Low / Median / High Price $229.09 / $229.09 / $302.00	Facility		$229.09	$229.09	$302.00
United Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $120.23 / $295.12	Professional		$89.13	$120.23	$295.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $46.77 / $112.20	Professional	26	$34.67	$46.77	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $72.44 / $186.21	Professional	TC	$53.70	$72.44	$186.21