Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $22.39 / $26.92	Facility	26	$19.05	$22.39	$26.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $58.88 / $165.96	Professional		$36.31	$58.88	$165.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $22.39 / $57.54	Professional	26	$10.96	$22.39	$57.54
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $46.77 / $46.77 / $46.77	Professional	52	$46.77	$46.77	$46.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $32.36 / $70.79	Professional	TC	$22.39	$32.36	$70.79
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $67.61 / $204.17	Professional		$38.90	$67.61	$204.17
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $19.50 / $67.61	Professional	26	$12.59	$19.50	$67.61
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $40.74 / $144.54	Professional	TC	$23.44	$40.74	$144.54
CareSource Facility/Professional Professional Modifier Low / Median / High Price $16.60 / $38.90 / $57.54	Professional		$16.60	$38.90	$57.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $39.81 / $64.57	Facility	26	$33.88	$39.81	$64.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $95.50 / $181.97	Professional		$41.69	$95.50	$181.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $28.84 / $52.48	Professional	26	$13.49	$28.84	$52.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $69.18 / $131.83	Professional	TC	$26.92	$69.18	$131.83
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $97.72 / $128.82	Professional		$83.18	$97.72	$128.82
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $28.84 / $37.15	Professional	26	$23.99	$28.84	$37.15
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $70.79 / $91.20	Professional	TC	$57.54	$70.79	$91.20
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $79.43 / $79.43	Facility	26	$79.43	$79.43	$79.43
Medica Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $75.86 / $288.40	Professional		$41.69	$75.86	$288.40
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $26.30 / $83.18	Professional	26	$14.13	$26.30	$83.18
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $50.12 / $208.93	Professional	TC	$27.54	$50.12	$208.93
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 $56.23 / $109.65 / $154.88	Professional		$56.23	$109.65	$154.88
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $83.18 / $83.18	Facility	26	$30.20	$83.18	$83.18
Quartz Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $213.80 / $288.40	Professional		$47.86	$213.80	$288.40
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $67.61 / $83.18	Professional	26	$15.14	$67.61	$83.18
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $144.54 / $208.93	Professional	TC	$33.88	$144.54	$208.93
Security Health Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $281.84 / $338.84	Professional		$123.03	$281.84	$338.84
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $95.50 / $131.83	Professional	26	$45.71	$95.50	$131.83
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $154.88 / $190.55	Professional	TC	$69.18	$154.88	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $61.66 / $154.88	Professional		$41.69	$61.66	$154.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $20.89 / $45.71	Professional	26	$13.80	$20.89	$45.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $41.69 / $104.71	Professional	TC	$27.54	$41.69	$104.71