Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $134.90 / $173.78 / $257.04	Facility	26	$134.90	$173.78	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $398.11 / $1,778.28	Professional		$81.28	$398.11	$1,778.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $138.04 / $588.84	Professional	26	$61.66	$138.04	$588.84
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $229.09 / $1,096.48 / $1,778.28	Professional	50	$229.09	$1,096.48	$1,778.28
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $100.00 / $223.87 / $1,023.29	Professional	52	$100.00	$223.87	$1,023.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $281.84 / $977.24	Professional	TC	$141.25	$281.84	$977.24
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $389.05 / $1,202.26	Professional		$204.17	$389.05	$1,202.26
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $100.00 / $363.08	Professional	26	$63.10	$100.00	$363.08
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $302.00 / $588.84 / $1,778.28	Professional	50	$302.00	$588.84	$1,778.28
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $288.40 / $831.76	Professional	TC	$141.25	$288.40	$831.76
CareSource Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $169.82 / $263.03	Professional		$81.28	$169.82	$263.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $194.98 / $316.23	Facility	26	$169.82	$194.98	$316.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $602.56 / $851.14	Professional		$234.42	$602.56	$851.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $147.91 / $263.03	Professional	26	$58.88	$147.91	$263.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $436.52 / $588.84	Professional	TC	$169.82	$436.52	$588.84
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $457.09 / $616.60	Professional		$380.19	$457.09	$616.60
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $141.25 / $190.55	Professional	26	$117.49	$141.25	$190.55
DeanCare Facility/Professional Professional Modifier 50 Low / Median / High Price $575.44 / $676.08 / $933.25	Professional	50	$575.44	$676.08	$933.25
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $316.23 / $426.58	Professional	TC	$263.03	$316.23	$426.58
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $478.63 / $602.56 / $1,949.84	Facility	26	$478.63	$602.56	$1,949.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $660.69 / $2,818.38	Professional		$263.03	$660.69	$2,818.38
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $194.98 / $562.34	Professional	26	$75.86	$194.98	$562.34
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $467.74 / $2,454.71	Professional	TC	$186.21	$467.74	$2,454.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $524.81	Professional		$32.36	$33.11	$524.81
Quartz Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $524.81 / $2,089.30	Professional		$269.15	$524.81	$2,089.30
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $147.91 / $588.84 / $588.84	Facility	26	$147.91	$588.84	$588.84
Quartz Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $1,621.81 / $2,884.03	Professional		$323.59	$1,621.81	$2,884.03
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $331.13 / $524.81	Professional	26	$81.28	$331.13	$524.81
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $1,380.38 / $2,511.89	Professional	TC	$218.78	$1,380.38	$2,511.89
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,698.24 / $2,818.38	Professional		$1,318.26	$1,698.24	$2,818.38
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $302.00 / $407.38 / $831.76	Professional	26	$302.00	$407.38	$831.76
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $933.25 / $1,258.93 / $1,995.26	Professional	TC	$933.25	$1,258.93	$1,995.26
United Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $457.09 / $977.24	Professional		$234.42	$457.09	$977.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $112.20 / $245.47	Professional	26	$69.18	$112.20	$245.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $323.59 / $741.31	Professional	TC	$165.96	$323.59	$741.31