Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $97.72 / $120.23	Facility	26	$70.79	$97.72	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $245.47 / $676.08	Professional		$134.90	$245.47	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $70.79 / $190.55	Professional	26	$43.65	$70.79	$190.55
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $30.20 / $30.20	Professional	52	$30.20	$30.20	$30.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $131.83 / $380.19	Professional	TC	$95.50	$131.83	$380.19
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $239.88 / $831.76	Professional		$154.88	$239.88	$831.76
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $70.79 / $251.19	Professional	26	$45.71	$70.79	$251.19
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $165.96 / $575.44	Professional	TC	$107.15	$165.96	$575.44
CareSource Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $134.90 / $204.17	Professional		$60.26	$134.90	$204.17
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $144.54 / $234.42	Facility	26	$125.89	$144.54	$234.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $338.84 / $645.65	Professional		$169.82	$338.84	$645.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $97.72 / $190.55	Professional	26	$50.12	$97.72	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $239.88 / $457.09	Professional	TC	$123.03	$239.88	$457.09
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $346.74 / $457.09	Professional		$295.12	$346.74	$457.09
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $104.71 / $134.90	Professional	26	$87.10	$104.71	$134.90
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $245.47 / $323.59	Professional	TC	$204.17	$245.47	$323.59
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $363.08	Facility	26	$213.80	$213.80	$363.08
Medica Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $309.03 / $1,023.29	Professional		$177.83	$309.03	$1,023.29
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $112.20 / $302.00	Professional	26	$53.70	$112.20	$302.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $213.80 / $724.44	Professional	TC	$120.23	$213.80	$724.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $70.79	Professional		$32.36	$33.11	$70.79
Quartz Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $371.54 / $549.54	Professional		$204.17	$371.54	$549.54
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $302.00 / $302.00	Facility	26	$109.65	$302.00	$302.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $812.83 / $1,023.29	Professional		$199.53	$812.83	$1,023.29
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $245.47 / $302.00	Professional	26	$57.54	$245.47	$302.00
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $575.44 / $724.44	Professional	TC	$144.54	$575.44	$724.44
Security Health Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $501.19 / $1,000.00	Professional		$398.11	$501.19	$1,000.00
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $138.04 / $223.87	Professional	26	$117.49	$138.04	$223.87
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $309.03 / $524.81	Professional	TC	$263.03	$309.03	$524.81
United Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $251.19 / $588.84	Professional		$169.82	$251.19	$588.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $75.86 / $173.78	Professional	26	$51.29	$75.86	$173.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $177.83 / $407.38	Professional	TC	$120.23	$177.83	$407.38