Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $141.25 / $194.98	Facility	26	$141.25	$141.25	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $151.36 / $331.13	Professional		$109.65	$151.36	$331.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $56.23 / $117.49	Professional	TC	$39.81	$56.23	$117.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $218.78 / $776.25	Professional		$141.25	$218.78	$776.25
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $79.43 / $275.42	Professional	TC	$48.98	$79.43	$275.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $245.47 / $288.40 / $457.09	Facility	26	$245.47	$288.40	$457.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $467.74 / $602.56	Professional		$208.93	$467.74	$602.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $165.96 / $218.78	Professional	TC	$75.86	$165.96	$218.78
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $338.84 / $407.38	Professional		$288.40	$338.84	$407.38
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $123.03 / $151.36	Professional	TC	$107.15	$123.03	$151.36
Medica Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $354.81 / $1,148.15	Professional		$165.96	$354.81	$1,148.15
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $125.89 / $588.84	Professional	TC	$56.23	$125.89	$588.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $162.18	Professional		$32.36	$33.11	$162.18
Quartz Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $338.84 / $630.96	Professional		$218.78	$338.84	$630.96
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $218.78 / $588.84 / $588.84	Facility	26	$218.78	$588.84	$588.84
Quartz Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $724.44 / $1,148.15	Professional		$234.42	$724.44	$1,148.15
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $331.13 / $602.56	Professional	TC	$87.10	$331.13	$602.56
Security Health Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $891.25 / $1,122.02	Professional		$467.74	$891.25	$1,122.02
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $158.49 / $281.84	Professional	TC	$144.54	$158.49	$281.84
United Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $263.03 / $645.65	Professional		$151.36	$263.03	$645.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $97.72 / $213.80	Professional	TC	$52.48	$97.72	$213.80