Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.29 / $25.40 / $25.40	Facility	26	$18.29	$25.40	$25.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.88 / $58.28 / $133.55	Professional		$36.88	$58.28	$133.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.44 / $14.13 / $61.75	Professional	26	$10.44	$14.13	$61.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.01 / $34.60 / $59.20	Professional	TC	$26.01	$34.60	$59.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.28 / $83.56 / $237.61	Professional		$39.28	$83.56	$237.61
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.09 / $24.72 / $71.63	Professional	26	$11.09	$24.72	$71.63
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.09 / $59.45 / $166.04	Professional	TC	$28.09	$59.45	$166.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $13.48 / $35.86 / $56.90	Professional		$13.48	$35.86	$56.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.54 / $36.86 / $48.98	Facility	26	$31.54	$36.86	$48.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.41 / $148.68 / $168.95	Professional		$42.41	$148.68	$168.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.98 / $42.77 / $48.60	Professional	26	$11.98	$42.77	$48.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.34 / $105.92 / $120.36	Professional	TC	$30.34	$105.92	$120.36
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $90.57 / $100.00 / $100.00	Facility	26	$90.57	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $43.48 / $98.48 / $271.52	Professional		$43.48	$98.48	$271.52
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.44 / $31.40 / $97.41	Professional	26	$13.44	$31.40	$97.41
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $29.16 / $68.91 / $210.00	Professional	TC	$29.16	$68.91	$210.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.34 / $42.33 / $77.04	Professional		$19.34	$42.33	$77.04
Quartz Facility/Professional Professional Modifier Low / Median / High Price $81.90 / $122.70 / $189.95	Professional		$81.90	$122.70	$189.95
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $68.88 / $195.25 / $271.52	Professional		$68.88	$195.25	$271.52
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $18.14 / $62.80 / $97.41	Professional	26	$18.14	$62.80	$97.41
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $46.06 / $132.44 / $210.00	Professional	TC	$46.06	$132.44	$210.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $81.54 / $246.39 / $264.92	Professional		$81.54	$246.39	$264.92
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.98 / $31.86 / $61.21	Professional	26	$23.98	$31.86	$61.21
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.56 / $69.79 / $185.18	Professional	TC	$57.56	$69.79	$185.18
United Facility/Professional Professional Modifier Low / Median / High Price $41.14 / $89.58 / $171.14	Professional		$41.14	$89.58	$171.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.99 / $29.23 / $55.05	Professional	26	$12.99	$29.23	$55.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.37 / $59.04 / $116.09	Professional	TC	$28.37	$59.04	$116.09