Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $134.90 / $165.96	Facility	26	$117.49	$134.90	$165.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $281.84 / $758.58	Professional		$162.18	$281.84	$758.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $109.65 / $331.13	Professional	26	$57.54	$109.65	$331.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $158.49 / $288.40	Professional	TC	$100.00	$158.49	$288.40
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $316.23 / $933.25	Professional		$158.49	$316.23	$933.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $91.20 / $346.74	Professional	26	$58.88	$91.20	$346.74
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $208.93 / $630.96	Professional	TC	$100.00	$208.93	$630.96
CareSource Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $120.23 / $204.17	Professional		$77.62	$120.23	$204.17
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $158.49 / $186.21 / $295.12	Facility	26	$158.49	$186.21	$295.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $436.52 / $660.69	Professional		$199.53	$436.52	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $125.89 / $245.47	Professional	26	$56.23	$125.89	$245.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $275.42 / $416.87	Professional	TC	$141.25	$275.42	$416.87
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $354.81 / $588.84	Professional		$295.12	$354.81	$588.84
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $134.90 / $181.97	Professional	26	$112.20	$134.90	$181.97
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $223.87 / $426.58	Professional	TC	$186.21	$223.87	$426.58
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $575.44 / $575.44 / $575.44	Facility	26	$575.44	$575.44	$575.44
Medica Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $457.09 / $1,659.59	Professional		$234.42	$457.09	$1,659.59
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $144.54 / $524.81	Professional	26	$66.07	$144.54	$524.81
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $316.23 / $1,318.26	Professional	TC	$158.49	$316.23	$1,318.26
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $316.23	Professional		$32.36	$33.11	$316.23
Quartz Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $407.38 / $707.95	Professional		$208.93	$407.38	$707.95
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $562.34 / $562.34	Facility	26	$141.25	$562.34	$562.34
Quartz Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $851.14 / $1,659.59	Professional		$257.04	$851.14	$1,659.59
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $316.23 / $524.81	Professional	26	$75.86	$316.23	$524.81
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $616.60 / $1,318.26	Professional	TC	$158.49	$616.60	$1,318.26
Security Health Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $954.99 / $1,348.96	Professional		$724.44	$954.99	$1,348.96
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $208.93 / $229.09 / $288.40	Professional	26	$208.93	$229.09	$288.40
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $537.03 / $691.83	Professional	TC	$363.08	$537.03	$691.83
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $354.81 / $724.44	Professional		$194.98	$354.81	$724.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $102.33 / $229.09	Professional	26	$64.57	$102.33	$229.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $251.19 / $537.03	Professional	TC	$131.83	$251.19	$537.03