Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $91.20 / $281.84	Facility	26	$43.65	$91.20	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $208.93 / $851.14	Professional		$107.15	$208.93	$851.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $43.65 / $223.87	Professional	26	$36.31	$43.65	$223.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $109.65 / $275.42	Professional	TC	$64.57	$109.65	$275.42
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $177.83 / $616.60	Professional		$107.15	$177.83	$616.60
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $60.26 / $229.09	Professional	26	$38.90	$60.26	$229.09
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $123.03 / $389.05	Professional	TC	$67.61	$123.03	$389.05
CareSource Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $81.28 / $138.04	Professional		$51.29	$81.28	$138.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $123.03 / $194.98	Facility	26	$104.71	$123.03	$194.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $295.12 / $446.68	Professional		$109.65	$295.12	$446.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $85.11 / $162.18	Professional	26	$37.15	$85.11	$162.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $204.17 / $281.84	Professional	TC	$74.13	$204.17	$281.84
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $239.88 / $323.59	Professional		$199.53	$239.88	$323.59
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $89.13 / $120.23	Professional	26	$74.13	$89.13	$120.23
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $151.36 / $204.17	Professional	TC	$125.89	$151.36	$204.17
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $302.00 / $380.19 / $851.14	Facility	26	$302.00	$380.19	$851.14
Medica Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $288.40 / $1,258.93	Professional		$134.90	$288.40	$1,258.93
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $147.91 / $416.87	Professional	26	$47.86	$147.91	$416.87
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $186.21 / $1,096.48	Professional	TC	$83.18	$186.21	$1,096.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $190.55	Professional		$32.36	$33.11	$190.55
Quartz Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $269.15 / $812.83	Professional		$138.04	$269.15	$812.83
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $371.54 / $371.54	Facility	26	$100.00	$371.54	$371.54
Quartz Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $724.44 / $1,318.26	Professional		$154.88	$724.44	$1,318.26
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $208.93 / $316.23	Professional	26	$50.12	$208.93	$316.23
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $588.84 / $1,096.48	Professional	TC	$104.71	$588.84	$1,096.48
Security Health Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $676.08 / $912.01	Professional		$380.19	$676.08	$912.01
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $158.49 / $190.55	Professional	26	$141.25	$158.49	$190.55
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $281.84 / $524.81	Professional	TC	$234.42	$281.84	$524.81
United Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $218.78 / $457.09	Professional		$117.49	$218.78	$457.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $67.61 / $151.36	Professional	26	$43.65	$67.61	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $144.54 / $346.74	Professional	TC	$74.13	$144.54	$346.74