Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $72.44 / $89.13	Facility	26	$52.48	$72.44	$89.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $125.89 / $407.38	Professional		$67.61	$125.89	$407.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $52.48 / $218.78	Professional	26	$28.84	$52.48	$218.78
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $85.11 / $229.09 / $724.44	Professional	50	$85.11	$229.09	$724.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $74.13 / $154.88	Professional	TC	$54.95	$74.13	$154.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $154.88 / $478.63	Professional		$100.00	$154.88	$478.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $52.48 / $158.49	Professional	26	$33.88	$52.48	$158.49
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $151.36 / $234.42 / $707.95	Professional	50	$151.36	$234.42	$707.95
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $102.33 / $316.23	Professional	TC	$66.07	$102.33	$316.23
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $81.28 / $213.80	Professional		$39.81	$81.28	$213.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $107.15 / $169.82	Facility	26	$91.20	$107.15	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $239.88 / $416.87	Professional		$109.65	$239.88	$416.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $79.43 / $141.25	Professional	26	$38.02	$79.43	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $162.18 / $275.42	Professional	TC	$72.44	$162.18	$275.42
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $213.80 / $288.40	Professional		$186.21	$213.80	$288.40
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $72.44 / $97.72	Professional	26	$63.10	$72.44	$97.72
DeanCare Facility/Professional Professional Modifier 50 Low / Median / High Price $281.84 / $316.23 / $426.58	Professional	50	$281.84	$316.23	$426.58
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $141.25 / $190.55	Professional	TC	$123.03	$141.25	$190.55
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $158.49 / $158.49 / $158.49	Facility	26	$158.49	$158.49	$158.49
Medica Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $186.21 / $660.69	Professional		$109.65	$186.21	$660.69
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $64.57 / $218.78	Professional	26	$37.15	$64.57	$218.78
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $123.03 / $446.68	Professional	TC	$70.79	$123.03	$446.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $85.11	Professional		$32.36	$33.11	$85.11
Quartz Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $234.42 / $354.81	Professional		$128.82	$234.42	$354.81
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $218.78 / $218.78	Facility	26	$81.28	$218.78	$218.78
Quartz Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $524.81 / $660.69	Professional		$93.33	$524.81	$660.69
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $177.83 / $218.78	Professional	26	$30.90	$177.83	$218.78
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $338.84 / $446.68	Professional	TC	$61.66	$338.84	$446.68
Security Health Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $389.05 / $645.65	Professional		$263.03	$389.05	$645.65
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $104.71 / $162.18	Professional	26	$89.13	$104.71	$162.18
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $199.53 / $323.59	Professional	TC	$169.82	$199.53	$323.59
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $147.91 / $363.08	Professional		$107.15	$147.91	$363.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $50.12 / $120.23	Professional	26	$37.15	$50.12	$120.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $95.50 / $245.47	Professional	TC	$70.79	$95.50	$245.47