Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $85.11 / $295.12	Facility	26	$85.11	$85.11	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $169.82 / $389.05	Professional		$134.90	$169.82	$389.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $83.18 / $263.03	Professional	26	$72.44	$83.18	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $83.18 / $131.83	Professional	TC	$66.07	$83.18	$131.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $234.42 / $562.34	Professional		$158.49	$234.42	$562.34
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $120.23 / $281.84	Professional	26	$81.28	$120.23	$281.84
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $117.49 / $288.40	Professional	TC	$77.62	$117.49	$288.40
CareSource Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $104.71 / $194.98	Professional		$83.18	$104.71	$194.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $245.47 / $398.11	Facility	26	$213.80	$245.47	$398.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $416.87 / $575.44	Professional		$173.78	$416.87	$575.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $208.93 / $302.00	Professional	26	$89.13	$208.93	$302.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $208.93 / $295.12	Professional	TC	$81.28	$208.93	$295.12
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $323.59 / $436.52	Professional		$275.42	$323.59	$436.52
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $165.96 / $223.87	Professional	26	$141.25	$165.96	$223.87
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $158.49 / $213.80	Professional	TC	$134.90	$158.49	$213.80
Medica Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $331.13 / $1,047.13	Professional		$138.04	$331.13	$1,047.13
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $169.82 / $512.86	Professional	26	$85.11	$169.82	$512.86
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $162.18 / $549.54	Professional	TC	$45.71	$162.18	$549.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $154.88	Professional		$32.36	$33.11	$154.88
Quartz Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $380.19 / $537.03	Professional		$208.93	$380.19	$537.03
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $186.21 / $512.86 / $512.86	Facility	26	$186.21	$512.86	$512.86
Quartz Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $831.76 / $1,047.13	Professional		$181.97	$831.76	$1,047.13
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $407.38 / $512.86	Professional	26	$95.50	$407.38	$512.86
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $426.58 / $549.54	Professional	TC	$93.33	$426.58	$549.54
Security Health Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $537.03 / $851.14	Professional		$245.47	$537.03	$851.14
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $208.93 / $263.03	Professional	26	$100.00	$208.93	$263.03
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $223.87 / $281.84	Professional	TC	$104.71	$223.87	$281.84
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $263.03 / $588.84	Professional		$144.54	$263.03	$588.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $134.90 / $288.40	Professional	26	$85.11	$134.90	$288.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $131.83 / $295.12	Professional	TC	$45.71	$131.83	$295.12