Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $66.07 / $66.07	Facility		$66.07	$66.07	$66.07
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $28.84 / $28.84	Facility	26	$28.84	$28.84	$28.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $74.13 / $245.47	Professional		$52.48	$74.13	$245.47
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $81.28 / $81.28 / $81.28	Professional	25	$81.28	$81.28	$81.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $26.92 / $186.21	Professional	26	$19.95	$26.92	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $33.88 / $66.07	Professional	TC	$25.70	$33.88	$66.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $120.23 / $213.80	Professional		$63.10	$120.23	$213.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $52.48 / $93.33	Professional	26	$27.54	$52.48	$93.33
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $102.33 / $181.97 / $323.59	Professional	50	$102.33	$181.97	$323.59
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $69.18 / $123.03	Professional	TC	$36.31	$69.18	$123.03
CareSource Facility/Professional Facility Modifier Low / Median / High Price $25.70 / $33.88 / $58.88	Facility		$25.70	$33.88	$58.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $204.17 / $281.84	Facility		$173.78	$204.17	$281.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $83.18 / $114.82	Facility	26	$70.79	$83.18	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $128.82 / $162.18	Professional		$64.57	$128.82	$162.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $54.95 / $67.61	Professional	26	$25.12	$54.95	$67.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $75.86 / $95.50	Professional	TC	$37.15	$75.86	$95.50
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $70.79 / $125.89	Facility		$50.12	$70.79	$125.89
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $131.83 / $177.83	Professional		$89.13	$131.83	$177.83
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $56.23 / $74.13	Professional	26	$38.02	$56.23	$74.13
DeanCare Facility/Professional Professional Modifier 52 Low / Median / High Price $89.13 / $131.83 / $177.83	Professional	52	$89.13	$131.83	$177.83
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $77.62 / $102.33	Professional	TC	$51.29	$77.62	$102.33
Medica Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $70.79 / $131.83	Facility		$50.12	$70.79	$131.83
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $151.36 / $151.36	Facility	26	$61.66	$151.36	$151.36
Medica Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $93.33 / $309.03	Professional		$61.66	$93.33	$309.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $34.67 / $165.96	Professional	26	$24.55	$34.67	$165.96
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $48.98 / $257.04	Professional	TC	$32.36	$48.98	$257.04
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 $70.79 / $141.25 / $204.17	Professional		$70.79	$141.25	$204.17
Quartz Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $398.11 / $398.11	Facility		$147.91	$398.11	$398.11
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $165.96 / $165.96	Facility	26	$100.00	$165.96	$165.96
Quartz Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $309.03 / $407.38	Professional		$54.95	$309.03	$407.38
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $138.04 / $165.96	Professional	26	$23.44	$138.04	$165.96
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $194.98 / $263.03	Professional	TC	$31.62	$194.98	$263.03
Security Health Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $223.87 / $223.87	Professional		$102.33	$223.87	$223.87
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $79.43 / $89.13	Professional	26	$43.65	$79.43	$89.13
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $54.95 / $89.13	Professional	TC	$20.89	$54.95	$89.13
United Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $77.62 / $147.91	Professional		$57.54	$77.62	$147.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $32.36 / $63.10	Professional	26	$23.99	$32.36	$63.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $44.67 / $85.11	Professional	TC	$32.36	$44.67	$85.11