Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $74.13 / $109.65	Facility	26	$64.57	$74.13	$109.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $107.15 / $512.86	Professional		$50.12	$107.15	$512.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $44.67 / $123.03	Professional	26	$23.99	$44.67	$123.03
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $213.80 / $213.80 / $213.80	Professional	50	$213.80	$213.80	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $26.92 / $114.82	Professional	TC	$10.00	$26.92	$114.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $107.15 / $346.74	Professional		$52.48	$107.15	$346.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $58.88 / $162.18	Professional	26	$31.62	$58.88	$162.18
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $77.62 / $158.49 / $512.86	Professional	50	$77.62	$158.49	$512.86
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $10.47 / $53.70 / $239.88	Professional	TC	$10.47	$53.70	$239.88
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.75 / $52.48 / $117.49	Professional		$11.75	$52.48	$117.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $131.83 / $213.80	Facility	26	$114.82	$131.83	$213.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $158.49 / $218.78	Professional		$77.62	$158.49	$218.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $89.13 / $177.83	Professional	26	$34.67	$89.13	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $38.90 / $107.15	Professional	TC	$16.22	$38.90	$107.15
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $112.20 / $162.18	Professional		$97.72	$112.20	$162.18
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $87.10 / $120.23	Professional	26	$77.62	$87.10	$120.23
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $21.88 / $72.44	Professional	TC	$19.05	$21.88	$72.44
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $194.98 / $194.98 / $194.98	Facility	26	$194.98	$194.98	$194.98
Medica Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $173.78 / $562.34	Professional		$87.10	$173.78	$562.34
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $54.95 / $263.03	Professional	26	$32.36	$54.95	$263.03
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $114.82 / $426.58	Professional	TC	$48.98	$114.82	$426.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $123.03	Professional		$32.36	$33.11	$123.03
Quartz Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $134.90 / $234.42	Professional		$69.18	$134.90	$234.42
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $208.93 / $208.93	Facility	26	$100.00	$208.93	$208.93
Quartz Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $380.19 / $575.44	Professional		$77.62	$380.19	$575.44
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $181.97 / $251.19	Professional	26	$33.11	$181.97	$251.19
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $223.87 / $446.68	Professional	TC	$15.14	$223.87	$446.68
Security Health Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $338.84 / $512.86	Professional		$288.40	$338.84	$512.86
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $91.20 / $154.88	Professional	26	$85.11	$91.20	$154.88
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $245.47 / $309.03	Professional	TC	$162.18	$245.47	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $141.25 / $309.03	Professional		$74.13	$141.25	$309.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $46.77 / $107.15	Professional	26	$31.62	$46.77	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $93.33 / $194.98	Professional	TC	$32.36	$93.33	$194.98