Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $22.39 / $22.39	Facility	26	$19.05	$22.39	$22.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $97.72 / $467.74	Professional		$54.95	$97.72	$467.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $30.90 / $141.25	Professional	26	$16.98	$30.90	$141.25
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $28.84 / $263.03 / $263.03	Professional	50	$28.84	$263.03	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $44.67 / $74.13	Professional	TC	$34.67	$44.67	$74.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $89.13 / $218.78	Professional		$60.26	$89.13	$218.78
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $26.30 / $64.57	Professional	26	$18.20	$26.30	$64.57
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $63.10 / $154.88	Professional	TC	$40.74	$63.10	$154.88
CareSource Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $50.12 / $75.86	Professional		$21.38	$50.12	$75.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $56.23 / $89.13	Facility	26	$47.86	$56.23	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $162.18 / $223.87	Professional		$66.07	$162.18	$223.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $47.86 / $61.66	Professional	26	$19.95	$47.86	$61.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $112.20 / $158.49	Professional	TC	$45.71	$112.20	$158.49
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $125.89 / $169.82	Professional		$107.15	$125.89	$169.82
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $38.02 / $51.29	Professional	26	$32.36	$38.02	$51.29
DeanCare Facility/Professional Professional Modifier 50 Low / Median / High Price $162.18 / $190.55 / $251.19	Professional	50	$162.18	$190.55	$251.19
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $87.10 / $117.49	Professional	TC	$74.13	$87.10	$117.49
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 $64.57 / $112.20 / $416.87	Professional		$64.57	$112.20	$416.87
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $36.31 / $114.82	Professional	26	$19.95	$36.31	$114.82
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $77.62 / $302.00	Professional	TC	$44.67	$77.62	$302.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $70.79	Professional		$32.36	$33.11	$70.79
Quartz Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $144.54 / $208.93	Professional		$83.18	$144.54	$208.93
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $42.66 / $42.66 / $114.82	Facility	26	$42.66	$42.66	$114.82
Quartz Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $302.00 / $416.87	Professional		$67.61	$302.00	$416.87
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $93.33 / $114.82	Professional	26	$20.89	$93.33	$114.82
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $213.80 / $302.00	Professional	TC	$46.77	$213.80	$302.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $181.97 / $331.13	Professional		$89.13	$181.97	$331.13
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $47.86 / $60.26	Professional	26	$22.91	$47.86	$60.26
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $97.72 / $128.82	Professional	TC	$57.54	$97.72	$128.82
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $100.00 / $213.80	Professional		$64.57	$100.00	$213.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $30.90 / $66.07	Professional	26	$19.05	$30.90	$66.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $69.18 / $151.36	Professional	TC	$44.67	$69.18	$151.36