Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $117.49 / $223.87	Facility	26	$117.49	$117.49	$223.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $131.83 / $389.05	Professional		$87.10	$131.83	$389.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $79.43 / $263.03	Professional	26	$56.23	$79.43	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $47.86 / $89.13	Professional	TC	$30.90	$47.86	$89.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $177.83 / $501.19	Professional		$93.33	$177.83	$501.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $100.00 / $295.12	Professional	26	$61.66	$100.00	$295.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $66.07 / $194.98	Professional	TC	$28.84	$66.07	$194.98
CareSource Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $69.18 / $134.90	Professional		$46.77	$69.18	$134.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $158.49 / $186.21 / $295.12	Facility	26	$158.49	$186.21	$295.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $288.40 / $354.81	Professional		$158.49	$288.40	$354.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $173.78 / $208.93	Professional	26	$93.33	$173.78	$208.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $123.03 / $154.88	Professional	TC	$66.07	$123.03	$154.88
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $251.19 / $295.12	Professional		$190.55	$251.19	$295.12
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $144.54 / $186.21	Professional	26	$109.65	$144.54	$186.21
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $97.72 / $125.89	Professional	TC	$77.62	$97.72	$125.89
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $281.84 / $281.84	Facility	26	$141.25	$281.84	$281.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $173.78 / $870.96	Professional		$102.33	$173.78	$870.96
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $117.49 / $380.19	Professional	26	$67.61	$117.49	$380.19
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $54.95 / $309.03	Professional	TC	$34.67	$54.95	$309.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $85.11	Professional		$32.36	$33.11	$85.11
Quartz Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $239.88 / $338.84	Professional		$134.90	$239.88	$338.84
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $380.19 / $380.19	Facility	26	$141.25	$380.19	$380.19
Quartz Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $489.78 / $870.96	Professional		$134.90	$489.78	$870.96
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $316.23 / $380.19	Professional	26	$91.20	$316.23	$380.19
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $186.21 / $309.03	Professional	TC	$54.95	$186.21	$309.03
Security Health Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $467.74 / $724.44	Professional		$316.23	$467.74	$724.44
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $218.78 / $263.03 / $323.59	Professional	26	$218.78	$263.03	$323.59
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $109.65 / $177.83	Professional	TC	$93.33	$109.65	$177.83
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $154.88 / $331.13	Professional		$100.00	$154.88	$331.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $100.00 / $218.78	Professional	26	$64.57	$100.00	$218.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $52.48 / $114.82	Professional	TC	$33.11	$52.48	$114.82