Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.84 / $27.79 / $27.79	Facility	26	$19.84	$27.79	$27.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.07 / $72.04 / $205.60	Professional		$50.07	$72.04	$205.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.80 / $14.70 / $33.01	Professional	26	$11.80	$14.70	$33.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.67 / $51.56 / $205.00	Professional	TC	$36.67	$51.56	$205.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.89 / $122.50 / $331.68	Professional		$53.89	$122.50	$331.68
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.80 / $29.57 / $85.88	Professional	26	$12.80	$29.57	$85.88
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $79.31 / $190.02 / $529.67	Professional	50	$79.31	$190.02	$529.67
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.34 / $94.32 / $256.45	Professional	TC	$40.34	$94.32	$256.45
CareSource Facility/Professional Professional Modifier Low / Median / High Price $14.80 / $54.54 / $81.81	Professional		$14.80	$54.54	$81.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.24 / $40.02 / $53.18	Facility	26	$34.24	$40.02	$53.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.03 / $210.91 / $239.68	Professional		$60.03	$210.91	$239.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.35 / $46.37 / $52.69	Professional	26	$16.35	$46.37	$52.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.13 / $164.54 / $186.98	Professional	TC	$44.13	$164.54	$186.98
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $70.00 / $70.00 / $70.00	Facility	26	$70.00	$70.00	$70.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $58.15 / $134.55 / $379.94	Professional		$58.15	$134.55	$379.94
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $15.53 / $35.44 / $83.23	Professional	26	$15.53	$35.44	$83.23
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $42.59 / $97.37 / $296.70	Professional	TC	$42.59	$97.37	$296.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.04 / $56.21 / $123.82	Professional		$25.04	$56.21	$123.82
Quartz Facility/Professional Professional Modifier Low / Median / High Price $71.19 / $143.56 / $221.16	Professional		$71.19	$143.56	$221.16
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $31.50 / $70.00 / $70.00	Facility	26	$31.50	$70.00	$70.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $88.83 / $269.10 / $379.94	Professional		$88.83	$269.10	$379.94
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $21.02 / $68.15 / $83.23	Professional	26	$21.02	$68.15	$83.23
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $69.30 / $201.20 / $296.70	Professional	TC	$69.30	$201.20	$296.70
Security Health Facility/Professional Professional Modifier Low / Median / High Price $99.99 / $375.85 / $375.85	Professional		$99.99	$375.85	$375.85
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.71 / $31.42 / $62.42	Professional	26	$26.71	$31.42	$62.42
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $67.73 / $79.68 / $205.01	Professional	TC	$67.73	$79.68	$205.01
United Facility/Professional Professional Modifier Low / Median / High Price $57.15 / $123.98 / $228.05	Professional		$57.15	$123.98	$228.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.19 / $31.21 / $59.81	Professional	26	$15.19	$31.21	$59.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.57 / $86.94 / $163.82	Professional	TC	$42.57	$86.94	$163.82