Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $64.57 / $389.05	Professional		$43.65	$64.57	$389.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $77.62 / $199.53	Professional	26	$28.84	$77.62	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $20.89 / $47.86	Professional	TC	$15.85	$20.89	$47.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $123.03 / $338.84	Professional		$23.44	$123.03	$338.84
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $81.28 / $223.87	Professional	26	$15.14	$81.28	$223.87
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $8.32 / $41.69 / $114.82	Professional	TC	$8.32	$41.69	$114.82
CareSource Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $44.67 / $81.28	Professional		$20.42	$44.67	$81.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $123.03 / $181.97	Facility	26	$107.15	$123.03	$181.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $74.13 / $181.97	Professional		$26.30	$74.13	$181.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $44.67 / $104.71	Professional	26	$16.22	$44.67	$104.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $28.18 / $61.66	Professional	TC	$10.00	$28.18	$61.66
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $151.36 / $169.82	Professional		$151.36	$151.36	$169.82
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $95.50 / $104.71	Professional	26	$95.50	$95.50	$104.71
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $58.88 / $66.07	Professional	TC	$58.88	$58.88	$66.07
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $154.88 / $154.88 / $154.88	Facility	26	$154.88	$154.88	$154.88
Medica Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $75.86 / $478.63	Professional		$38.90	$75.86	$478.63
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $60.26 / $346.74	Professional	26	$25.70	$60.26	$346.74
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $25.12 / $331.13	Professional	TC	$14.45	$25.12	$331.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $50.12 / $70.79	Professional		$28.84	$50.12	$70.79
Quartz Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $138.04 / $190.55	Professional		$93.33	$138.04	$190.55
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $218.78	Facility	26	$100.00	$100.00	$218.78
Quartz Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $275.42 / $478.63	Professional		$26.30	$275.42	$478.63
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $181.97 / $346.74	Professional	26	$16.22	$181.97	$346.74
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $107.15 / $331.13	Professional	TC	$10.00	$107.15	$331.13
Security Health Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $128.82 / $288.40	Professional		$117.49	$128.82	$288.40
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $70.79 / $131.83	Professional	26	$70.79	$70.79	$131.83
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $14.13 / $67.61	Professional	TC	$14.13	$14.13	$67.61
United Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $54.95 / $134.90	Professional		$33.88	$54.95	$134.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $36.31 / $89.13	Professional	26	$22.39	$36.31	$89.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.75 / $18.20 / $48.98	Professional	TC	$11.75	$18.20	$48.98