Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.73 / $43.73 / $232.05	Facility		$43.73	$43.73	$232.05
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $28.18 / $112.68	Facility	26	$28.18	$28.18	$112.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.73 / $100.79 / $279.00	Professional		$43.73	$100.79	$279.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $43.40 / $139.40	Professional	26	$28.18	$43.40	$139.40
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $209.18 / $209.18 / $334.86	Professional	50	$209.18	$209.18	$334.86
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $19.75 / $23.79 / $137.15	Professional	52	$19.75	$23.79	$137.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.55 / $55.91 / $143.36	Professional	TC	$15.55	$55.91	$143.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.63 / $88.12 / $182.50	Professional		$52.63	$88.12	$182.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.35 / $46.25 / $95.00	Professional	26	$29.35	$46.25	$95.00
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $78.95 / $135.85 / $273.75	Professional	50	$78.95	$135.85	$273.75
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.77 / $37.36 / $103.05	Professional	TC	$19.77	$37.36	$103.05
CareSource Facility/Professional Facility Modifier Low / Median / High Price $16.89 / $37.56 / $60.45	Facility		$16.89	$37.56	$60.45
CareSource Facility/Professional Professional Modifier Low / Median / High Price $16.91 / $33.97 / $58.29	Professional		$16.91	$33.97	$58.29
Cigna Facility/Professional Facility Modifier Low / Median / High Price $127.06 / $148.47 / $227.77	Facility		$127.06	$148.47	$227.77
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.20 / $93.72 / $143.77	Facility	26	$80.20	$93.72	$143.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $73.76 / $96.88 / $132.44	Professional		$73.76	$96.88	$132.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.90 / $60.68 / $74.59	Professional	26	$34.90	$60.68	$74.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.56 / $37.43 / $69.44	Professional	TC	$28.56	$37.43	$69.44
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $43.69 / $66.75 / $132.43	Facility		$43.69	$66.75	$132.43
Medica Facility/Professional Facility Modifier Low / Median / High Price $43.69 / $69.13 / $177.40	Facility		$43.69	$69.13	$177.40
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $134.74 / $134.74 / $134.74	Facility	26	$134.74	$134.74	$134.74
Medica Facility/Professional Professional Modifier Low / Median / High Price $70.88 / $134.93 / $459.15	Professional		$70.88	$134.93	$459.15
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $31.76 / $57.19 / $188.73	Professional	26	$31.76	$57.19	$188.73
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $34.35 / $78.03 / $313.58	Professional	TC	$34.35	$78.03	$313.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.31 / $61.13 / $129.80	Professional		$26.31	$61.13	$129.80
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $42.00 / $66.75 / $132.43	Facility		$42.00	$66.75	$132.43
Quartz Facility/Professional Professional Modifier Low / Median / High Price $79.22 / $133.36 / $192.53	Professional		$79.22	$133.36	$192.53
Quartz Facility/Professional Facility Modifier Low / Median / High Price $113.18 / $267.77 / $267.77	Facility		$113.18	$267.77	$267.77
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $134.74 / $134.74	Facility	26	$100.00	$134.74	$134.74
Quartz Facility/Professional Professional Modifier Low / Median / High Price $87.26 / $304.10 / $459.15	Professional		$87.26	$304.10	$459.15
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $48.67 / $154.55 / $188.73	Professional	26	$48.67	$154.55	$188.73
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $32.71 / $183.02 / $313.58	Professional	TC	$32.71	$183.02	$313.58
Security Health Facility/Professional Professional Modifier Low / Median / High Price $136.76 / $166.72 / $173.04	Professional		$136.76	$166.72	$173.04
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.70 / $57.92 / $90.12	Professional	26	$48.70	$57.92	$90.12
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.72 / $88.06 / $177.26	Professional	TC	$31.72	$88.06	$177.26
United Facility/Professional Professional Modifier Low / Median / High Price $63.52 / $119.82 / $185.85	Professional		$63.52	$119.82	$185.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.76 / $46.45 / $88.29	Professional	26	$31.76	$46.45	$88.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.76 / $66.47 / $104.68	Professional	TC	$31.76	$66.47	$104.68