Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $39.81 / $138.04	Facility	26	$39.81	$39.81	$138.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $275.42 / $891.25	Professional		$169.82	$275.42	$891.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $45.71 / $147.91	Professional	26	$33.88	$45.71	$147.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $181.97 / $436.52	Professional	TC	$138.04	$181.97	$436.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $288.40 / $758.58	Professional		$194.98	$288.40	$758.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $57.54 / $147.91	Professional	26	$38.02	$57.54	$147.91
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $234.42 / $616.60	Professional	TC	$154.88	$234.42	$616.60
CareSource Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $165.96 / $269.15	Professional		$38.90	$165.96	$269.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $114.82 / $181.97	Facility	26	$97.72	$114.82	$181.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $489.78 / $588.84	Professional		$208.93	$489.78	$588.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $93.33 / $112.20	Professional	26	$37.15	$93.33	$112.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $398.11 / $478.63	Professional	TC	$169.82	$398.11	$478.63
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $389.05 / $524.81	Professional		$338.84	$389.05	$524.81
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $77.62 / $104.71	Professional	26	$67.61	$77.62	$104.71
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $309.03 / $416.87	Professional	TC	$275.42	$309.03	$416.87
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $208.93 / $208.93 / $660.69	Facility	26	$208.93	$208.93	$660.69
Medica Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $380.19 / $1,584.89	Professional		$223.87	$380.19	$1,584.89
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $67.61 / $426.58	Professional	26	$35.48	$67.61	$426.58
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $316.23 / $1,412.54	Professional	TC	$186.21	$316.23	$1,412.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $295.12	Professional		$32.36	$33.11	$295.12
Quartz Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $446.68 / $630.96	Professional		$245.47	$446.68	$630.96
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $239.88 / $239.88	Facility	26	$100.00	$239.88	$239.88
Quartz Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $954.99 / $1,621.81	Professional		$208.93	$954.99	$1,621.81
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $194.98 / $426.58	Professional	26	$38.90	$194.98	$426.58
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $776.25 / $1,445.44	Professional	TC	$165.96	$776.25	$1,445.44
Security Health Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $588.84 / $977.24	Professional		$416.87	$588.84	$977.24
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $100.00 / $125.89	Professional	26	$89.13	$100.00	$125.89
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $398.11 / $616.60	Professional	TC	$316.23	$398.11	$616.60
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $309.03 / $645.65	Professional		$204.17	$309.03	$645.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $54.95 / $123.03	Professional	26	$36.31	$54.95	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $257.04 / $524.81	Professional	TC	$162.18	$257.04	$524.81