Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.99 / $13.88 / $16.30	Facility	26	$9.99	$13.88	$16.30
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $46.57 / $249.34 / $407.53	Facility	TC	$46.57	$249.34	$407.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.41 / $60.76 / $204.00	Professional		$28.41	$60.76	$204.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.35 / $15.91 / $68.16	Professional	26	$6.35	$15.91	$68.16
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $31.50 / $31.50 / $31.50	Professional	50	$31.50	$31.50	$31.50
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.90 / $27.75 / $102.92	Professional	52	$15.90	$27.75	$102.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.59 / $46.57 / $193.35	Professional	TC	$26.59	$46.57	$193.35
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.53 / $74.53 / $207.70	Professional		$32.53	$74.53	$207.70
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.44 / $14.88 / $41.44	Professional	26	$6.44	$14.88	$41.44
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $49.77 / $120.28 / $335.01	Professional	50	$49.77	$120.28	$335.01
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.65 / $58.76 / $171.47	Professional	TC	$25.65	$58.76	$171.47
CareSource Facility/Professional Professional Modifier Low / Median / High Price $7.38 / $35.24 / $51.51	Professional		$7.38	$35.24	$51.51
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.12 / $20.01 / $26.59	Facility	26	$17.12	$20.01	$26.59
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $86.51 / $101.09 / $134.36	Facility	TC	$86.51	$101.09	$134.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.86 / $133.96 / $152.22	Professional		$33.86	$133.96	$152.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.32 / $23.36 / $26.55	Professional	26	$7.32	$23.36	$26.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.56 / $110.59 / $125.68	Professional	TC	$26.56	$110.59	$125.68
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $129.00	Facility	26	$100.00	$100.00	$129.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $88.77 / $219.78 / $350.00	Facility	TC	$88.77	$219.78	$350.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $36.09 / $88.89 / $241.48	Professional		$36.09	$88.89	$241.48
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $7.83 / $20.44 / $53.24	Professional	26	$7.83	$20.44	$53.24
Medica Facility/Professional Professional Modifier 52 Low / Median / High Price $135.00 / $135.00 / $135.00	Professional	52	$135.00	$135.00	$135.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $28.72 / $64.95 / $199.06	Professional	TC	$28.72	$64.95	$199.06
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.34 / $35.53 / $77.04	Professional		$19.34	$35.53	$77.04
Quartz Facility/Professional Professional Modifier Low / Median / High Price $74.75 / $97.88 / $137.44	Professional		$74.75	$97.88	$137.44
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 Facility Modifier TC Low / Median / High Price $100.00 / $143.82 / $143.82	Facility	TC	$100.00	$143.82	$143.82
Quartz Facility/Professional Professional Modifier Low / Median / High Price $56.43 / $170.20 / $241.48	Professional		$56.43	$170.20	$241.48
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $10.82 / $34.29 / $51.19	Professional	26	$10.82	$34.29	$51.19
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $46.59 / $135.85 / $199.06	Professional	TC	$46.59	$135.85	$199.06
Security Health Facility/Professional Professional Modifier Low / Median / High Price $67.47 / $211.72 / $238.72	Professional		$67.47	$211.72	$238.72
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.31 / $19.37 / $37.79	Professional	26	$15.31	$19.37	$37.79
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.45 / $52.22 / $155.11	Professional	TC	$39.45	$52.22	$155.11
United Facility/Professional Professional Modifier Low / Median / High Price $36.09 / $69.47 / $141.72	Professional		$36.09	$69.47	$141.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.22 / $15.71 / $30.06	Professional	26	$7.22	$15.71	$30.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.72 / $62.24 / $119.26	Professional	TC	$28.72	$62.24	$119.26