Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $44.67 / $64.57	Facility	26	$44.67	$44.67	$64.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $72.44 / $169.82	Professional		$54.95	$72.44	$169.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $30.90 / $85.11	Professional	26	$22.91	$30.90	$85.11
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $66.07 / $213.80 / $257.04	Professional	50	$66.07	$213.80	$257.04
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $91.20 / $91.20 / $91.20	Professional	52	$91.20	$91.20	$91.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $40.74 / $77.62	Professional	TC	$28.18	$40.74	$77.62
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $100.00 / $346.74	Professional		$64.57	$100.00	$346.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $45.71 / $144.54	Professional	26	$29.51	$45.71	$144.54
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $97.72 / $151.36 / $512.86	Professional	50	$97.72	$151.36	$512.86
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $54.95 / $190.55	Professional	TC	$35.48	$54.95	$190.55
CareSource Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $45.71 / $83.18	Professional		$32.36	$45.71	$83.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $93.33 / $147.91	Facility	26	$79.43	$93.33	$147.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $162.18 / $281.84	Professional		$77.62	$162.18	$281.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $70.79 / $123.03	Professional	26	$30.90	$70.79	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $95.50 / $154.88	Professional	TC	$46.77	$95.50	$154.88
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $141.25 / $190.55	Professional		$123.03	$141.25	$190.55
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $63.10 / $85.11	Professional	26	$54.95	$63.10	$85.11
DeanCare Facility/Professional Professional Modifier 50 Low / Median / High Price $186.21 / $213.80 / $288.40	Professional	50	$186.21	$213.80	$288.40
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $79.43 / $109.65	Professional	TC	$69.18	$79.43	$109.65
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $134.90 / $134.90 / $134.90	Facility	26	$134.90	$134.90	$134.90
Medica Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $144.54 / $501.19	Professional		$69.18	$144.54	$501.19
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $57.54 / $323.59	Professional	26	$30.90	$57.54	$323.59
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $81.28 / $323.59	Professional	TC	$38.02	$81.28	$323.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $91.20	Professional		$32.36	$33.11	$91.20
Quartz Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $173.78 / $302.00	Professional		$89.13	$173.78	$302.00
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $190.55 / $190.55	Facility	26	$100.00	$190.55	$190.55
Quartz Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $323.59 / $501.19	Professional		$72.44	$323.59	$501.19
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $154.88 / $323.59	Professional	26	$29.51	$154.88	$323.59
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $169.82 / $323.59	Professional	TC	$46.77	$169.82	$323.59
Security Health Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $302.00 / $489.78	Professional		$204.17	$302.00	$489.78
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $97.72 / $141.25	Professional	26	$91.20	$97.72	$141.25
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $151.36 / $190.55	Professional	TC	$109.65	$151.36	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $107.15 / $234.42	Professional		$67.61	$107.15	$234.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $42.66 / $102.33	Professional	26	$30.20	$42.66	$102.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $61.66 / $128.82	Professional	TC	$36.31	$61.66	$128.82