Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $57.54 / $107.15	Facility	26	$48.98	$57.54	$107.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $173.78 / $426.58	Professional		$128.82	$173.78	$426.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $72.44 / $295.12	Professional	26	$33.88	$72.44	$295.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $125.89 / $331.13	Professional	TC	$91.20	$125.89	$331.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $74.13 / $758.58	Professional		$74.13	$74.13	$758.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $22.39 / $190.55	Professional	26	$22.39	$22.39	$190.55
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $54.95 / $562.34	Professional	TC	$54.95	$54.95	$562.34
CareSource Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $134.90 / $269.15	Professional		$42.66	$134.90	$269.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $131.83 / $208.93	Facility	26	$112.20	$131.83	$208.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $281.84 / $575.44	Professional		$81.28	$281.84	$575.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $67.61 / $138.04	Professional	26	$21.38	$67.61	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $213.80 / $436.52	Professional	TC	$57.54	$213.80	$436.52
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $467.74 / $524.81	Professional		$467.74	$467.74	$524.81
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $114.82 / $125.89	Professional	26	$114.82	$114.82	$125.89
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $363.08 / $398.11	Professional	TC	$363.08	$363.08	$398.11
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $239.88 / $239.88 / $239.88	Facility	26	$239.88	$239.88	$239.88
Medica Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $173.78 / $1,148.15	Professional		$120.23	$173.78	$1,148.15
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $57.54 / $323.59	Professional	26	$39.81	$57.54	$323.59
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $131.83 / $870.96	Professional	TC	$83.18	$131.83	$870.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $54.95 / $316.23	Professional		$32.36	$54.95	$316.23
Quartz Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $398.11 / $562.34	Professional		$194.98	$398.11	$562.34
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $269.15 / $269.15	Facility	26	$102.33	$269.15	$269.15
Quartz Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $870.96 / $1,148.15	Professional		$81.28	$870.96	$1,148.15
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $288.40 / $331.13	Professional	26	$21.38	$288.40	$331.13
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $660.69 / $870.96	Professional	TC	$57.54	$660.69	$870.96
Security Health Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $181.97 / $912.01	Professional		$181.97	$181.97	$912.01
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $33.88 / $162.18	Professional	26	$33.88	$33.88	$162.18
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $95.50 / $457.09	Professional	TC	$95.50	$95.50	$457.09
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $173.78 / $331.13	Professional		$107.15	$173.78	$331.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $44.67 / $123.03	Professional	26	$26.92	$44.67	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $125.89 / $234.42	Professional	TC	$74.13	$125.89	$234.42