Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $162.18 / $162.18	Facility	26	$141.25	$162.18	$162.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $338.84 / $977.24	Professional		$199.53	$338.84	$977.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $169.82 / $562.34	Professional	26	$120.23	$169.82	$562.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $91.20 / $165.96	Professional	TC	$75.86	$91.20	$165.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $302.00 / $707.95	Professional		$213.80	$302.00	$707.95
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $186.21 / $416.87	Professional	26	$128.82	$186.21	$416.87
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $117.49 / $281.84	Professional	TC	$85.11	$117.49	$281.84
CareSource Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $165.96 / $269.15	Professional		$87.10	$165.96	$269.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $346.74 / $398.11 / $645.65	Facility	26	$346.74	$398.11	$645.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $549.54 / $758.58	Professional		$245.47	$549.54	$758.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $338.84 / $446.68	Professional	26	$141.25	$338.84	$446.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $213.80 / $295.12	Professional	TC	$93.33	$213.80	$295.12
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $436.52 / $588.84	Professional		$371.54	$436.52	$588.84
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $229.09 / $281.84 / $363.08	Professional	26	$229.09	$281.84	$363.08
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $165.96 / $239.88	Professional	TC	$141.25	$165.96	$239.88
Medica Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $426.58 / $1,380.38	Professional		$245.47	$426.58	$1,380.38
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $263.03 / $831.76	Professional	26	$147.91	$263.03	$831.76
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $177.83 / $549.54	Professional	TC	$107.15	$177.83	$549.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $173.78	Professional		$32.36	$33.11	$173.78
Quartz Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $489.78 / $724.44	Professional		$288.40	$489.78	$724.44
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $302.00 / $302.00 / $831.76	Facility	26	$302.00	$302.00	$831.76
Quartz Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $1,122.02 / $1,380.38	Professional		$251.19	$1,122.02	$1,380.38
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $660.69 / $831.76	Professional	26	$154.88	$660.69	$831.76
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $457.09 / $549.54	Professional	TC	$102.33	$457.09	$549.54
Security Health Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $741.31 / $1,122.02	Professional		$316.23	$741.31	$1,122.02
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $338.84 / $426.58	Professional	26	$117.49	$338.84	$426.58
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $245.47 / $309.03	Professional	TC	$104.71	$245.47	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $380.19 / $794.33	Professional		$234.42	$380.19	$794.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $223.87 / $467.74	Professional	26	$138.04	$223.87	$467.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $154.88 / $323.59	Professional	TC	$97.72	$154.88	$323.59