Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $16.67 / $92.30 / $135.85	Facility		$16.67	$92.30	$135.85
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.51 / $16.00 / $16.00	Facility	26	$11.51	$16.00	$16.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.75 / $17.47 / $75.29	Professional		$10.75	$17.47	$75.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.02 / $9.27 / $18.20	Professional	26	$7.02	$9.27	$18.20
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $11.36 / $11.36 / $11.36	Professional	50	$11.36	$11.36	$11.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $3.17 / $4.72 / $7.20	Professional	TC	$3.17	$4.72	$7.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.75 / $20.21 / $69.00	Professional		$10.75	$20.21	$69.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.43 / $13.96 / $45.72	Professional	26	$7.43	$13.96	$45.72
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $16.12 / $32.72 / $103.50	Professional	50	$16.12	$32.72	$103.50
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $3.33 / $6.30 / $21.25	Professional	TC	$3.33	$6.30	$21.25
CareSource Facility/Professional Facility Modifier Low / Median / High Price $3.61 / $9.75 / $14.70	Facility		$3.61	$9.75	$14.70
CareSource Facility/Professional Professional Modifier Low / Median / High Price $3.61 / $9.19 / $14.42	Professional		$3.61	$9.19	$14.42
Cigna Facility/Professional Facility Modifier Low / Median / High Price $28.84 / $33.70 / $51.69	Facility		$28.84	$33.70	$51.69
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.82 / $23.17 / $35.54	Facility	26	$19.82	$23.17	$35.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $14.31 / $39.04 / $44.38	Professional		$14.31	$39.04	$44.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.82 / $26.94 / $30.61	Professional	26	$10.82	$26.94	$30.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $4.53 / $12.14 / $13.80	Professional	TC	$4.53	$12.14	$13.80
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $10.06 / $16.67 / $36.61	Facility		$10.06	$16.67	$36.61
Medica Facility/Professional Facility Modifier Low / Median / High Price $10.06 / $16.67 / $109.11	Facility		$10.06	$16.67	$109.11
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $13.34 / $26.39 / $1,428.44	Professional		$13.34	$26.39	$1,428.44
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.38 / $18.21 / $1,274.28	Professional	26	$9.38	$18.21	$1,274.28
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $3.97 / $8.52 / $988.10	Professional	TC	$3.97	$8.52	$988.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $7.11 / $28.13 / $70.00	Professional		$7.11	$28.13	$70.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $10.06 / $16.67 / $32.57	Facility		$10.06	$16.67	$32.57
Quartz Facility/Professional Professional Modifier Low / Median / High Price $6.20 / $26.82 / $47.21	Professional		$6.20	$26.82	$47.21
Quartz Facility/Professional Facility Modifier Low / Median / High Price $26.53 / $109.11 / $109.11	Facility		$26.53	$109.11	$109.11
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $18.30 / $100.00 / $100.00	Facility	26	$18.30	$100.00	$100.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $16.45 / $57.25 / $1,428.44	Professional		$16.45	$57.25	$1,428.44
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $11.34 / $39.54 / $1,274.28	Professional	26	$11.34	$39.54	$1,274.28
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $5.11 / $17.70 / $988.10	Professional	TC	$5.11	$17.70	$988.10
Security Health Facility/Professional Professional Modifier Low / Median / High Price $19.28 / $69.59 / $69.59	Professional		$19.28	$69.59	$69.59
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.17 / $28.36 / $53.12	Professional	26	$15.17	$28.36	$53.12
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $3.03 / $14.53 / $31.12	Professional	TC	$3.03	$14.53	$31.12
United Facility/Professional Facility Modifier Low / Median / High Price $62.63 / $62.63 / $80.76	Facility		$62.63	$62.63	$80.76
United Facility/Professional Professional Modifier Low / Median / High Price $12.88 / $23.47 / $48.11	Professional		$12.88	$23.47	$48.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.19 / $17.46 / $34.67	Professional	26	$9.19	$17.46	$34.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $3.97 / $7.34 / $15.51	Professional	TC	$3.97	$7.34	$15.51