Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.58 / $29.97 / $29.97	Facility	26	$21.58	$29.97	$29.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.04 / $92.56 / $188.09	Professional		$54.04	$92.56	$188.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.32 / $21.58 / $90.91	Professional	26	$13.32	$21.58	$90.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.34 / $58.73 / $127.78	Professional	TC	$41.34	$58.73	$127.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.35 / $122.78 / $349.58	Professional		$59.35	$122.78	$349.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.92 / $31.92 / $88.92	Professional	26	$13.92	$31.92	$88.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.19 / $91.97 / $262.35	Professional	TC	$41.19	$91.97	$262.35
CareSource Facility/Professional Professional Modifier Low / Median / High Price $15.96 / $55.26 / $83.70	Professional		$15.96	$55.26	$83.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.85 / $44.23 / $58.78	Facility	26	$37.85	$44.23	$58.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $68.05 / $219.67 / $249.63	Professional		$68.05	$219.67	$249.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.76 / $50.46 / $57.34	Professional	26	$19.76	$50.46	$57.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.30 / $169.21 / $192.29	Professional	TC	$48.30	$169.21	$192.29
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $126.00 / $126.00 / $126.00	Facility	26	$126.00	$126.00	$126.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $63.62 / $149.05 / $399.42	Professional		$63.62	$149.05	$399.42
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $17.44 / $40.79 / $137.04	Professional	26	$17.44	$40.79	$137.04
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $46.47 / $109.90 / $356.00	Professional	TC	$46.47	$109.90	$356.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.04 / $57.26 / $123.82	Professional		$25.04	$57.26	$123.82
Quartz Facility/Professional Professional Modifier Low / Median / High Price $120.90 / $181.13 / $240.03	Professional		$120.90	$181.13	$240.03
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $126.00 / $126.00	Facility	26	$100.00	$126.00	$126.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $101.78 / $286.50 / $399.42	Professional		$101.78	$286.50	$399.42
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $23.38 / $75.25 / $137.04	Professional	26	$23.38	$75.25	$137.04
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $72.89 / $211.20 / $356.00	Professional	TC	$72.89	$211.20	$356.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $120.57 / $354.35 / $391.45	Professional		$120.57	$354.35	$391.45
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.11 / $50.76 / $99.96	Professional	26	$40.11	$50.76	$99.96
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $80.44 / $114.24 / $252.80	Professional	TC	$80.44	$114.24	$252.80
United Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $132.88 / $247.50	Professional		$63.10	$132.88	$247.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.14 / $36.50 / $66.04	Professional	26	$17.14	$36.50	$66.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.25 / $99.22 / $165.76	Professional	TC	$45.25	$99.22	$165.76