Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $20.99 / $84.29 / $125.05	Facility		$20.99	$84.29	$125.05
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.66 / $2.66 / $10.63	Facility	26	$2.66	$2.66	$10.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $20.99 / $33.29 / $88.02	Professional		$20.99	$33.29	$88.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.66 / $4.15 / $16.14	Professional	26	$2.66	$4.15	$16.14
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $10.27 / $12.83 / $31.46	Professional	52	$10.27	$12.83	$31.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.69 / $25.10 / $54.08	Professional	TC	$17.69	$25.10	$54.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $20.88 / $37.04 / $71.92	Professional		$20.88	$37.04	$71.92
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $2.95 / $5.53 / $9.82	Professional	26	$2.95	$5.53	$9.82
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $31.02 / $56.60 / $107.88	Professional	50	$31.02	$56.60	$107.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.93 / $32.27 / $61.76	Professional	TC	$17.93	$32.27	$61.76
CareSource Facility/Professional Facility Modifier Low / Median / High Price $3.12 / $20.42 / $28.78	Facility		$3.12	$20.42	$28.78
CareSource Facility/Professional Professional Modifier Low / Median / High Price $3.07 / $21.30 / $27.72	Professional		$3.07	$21.30	$27.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $63.08 / $73.70 / $97.97	Facility		$63.08	$73.70	$97.97
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.21 / $8.42 / $11.20	Facility	26	$7.21	$8.42	$11.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.57 / $46.06 / $59.41	Professional		$29.57	$46.06	$59.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $4.09 / $5.73 / $11.51	Professional	26	$4.09	$5.73	$11.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.31 / $40.33 / $49.50	Professional	TC	$25.31	$40.33	$49.50
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $20.53 / $31.03 / $66.27	Facility		$20.53	$31.03	$66.27
Medica Facility/Professional Facility Modifier Low / Median / High Price $19.95 / $31.67 / $125.02	Facility		$19.95	$31.67	$125.02
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 $24.13 / $48.17 / $311.26	Professional		$24.13	$48.17	$311.26
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $3.53 / $7.70 / $129.00	Professional	26	$3.53	$7.70	$129.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $20.60 / $38.13 / $252.63	Professional	TC	$20.60	$38.13	$252.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.10 / $33.89 / $70.00	Professional		$19.10	$33.89	$70.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $20.53 / $31.49 / $66.27	Facility		$20.53	$31.49	$66.27
Quartz Facility/Professional Professional Modifier Low / Median / High Price $34.72 / $53.22 / $75.90	Professional		$34.72	$53.22	$75.90
Quartz Facility/Professional Facility Modifier Low / Median / High Price $54.88 / $132.93 / $132.93	Facility		$54.88	$132.93	$132.93
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $41.90 / $153.09 / $311.26	Professional		$41.90	$153.09	$311.26
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $5.37 / $43.04 / $129.00	Professional	26	$5.37	$43.04	$129.00
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $36.60 / $110.04 / $252.63	Professional	TC	$36.60	$110.04	$252.63
Security Health Facility/Professional Professional Modifier Low / Median / High Price $31.10 / $80.87 / $80.87	Professional		$31.10	$80.87	$80.87
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $4.13 / $5.66 / $20.98	Professional	26	$4.13	$5.66	$20.98
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.52 / $26.51 / $50.47	Professional	TC	$22.52	$26.51	$50.47
United Facility/Professional Professional Modifier Low / Median / High Price $24.13 / $41.56 / $73.05	Professional		$24.13	$41.56	$73.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $3.51 / $6.18 / $13.78	Professional	26	$3.51	$6.18	$13.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.41 / $35.25 / $61.82	Professional	TC	$19.41	$35.25	$61.82