Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.39 / $29.70 / $29.70	Facility	26	$21.39	$29.70	$29.70
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $59.05 / $83.12 / $484.72	Facility	TC	$59.05	$83.12	$484.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.79 / $76.34 / $311.83	Professional		$46.79	$76.34	$311.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.30 / $21.39 / $123.50	Professional	26	$13.30	$21.39	$123.50
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $29.84 / $29.84 / $29.84	Professional	50	$29.84	$29.84	$29.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.14 / $52.66 / $204.00	Professional	TC	$33.14	$52.66	$204.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $49.38 / $111.47 / $305.24	Professional		$49.38	$111.47	$305.24
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $31.87 / $92.59	Professional	26	$13.80	$31.87	$92.59
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $73.16 / $173.52 / $492.96	Professional	50	$73.16	$173.52	$492.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.59 / $81.51 / $220.72	Professional	TC	$35.59	$81.51	$220.72
CareSource Facility/Professional Professional Modifier Low / Median / High Price $15.74 / $46.35 / $73.14	Professional		$15.74	$46.35	$73.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.95 / $43.17 / $57.38	Facility	26	$36.95	$43.17	$57.38
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $109.94 / $128.47 / $170.75	Facility	TC	$109.94	$128.47	$170.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.31 / $189.94 / $215.84	Professional		$56.31	$189.94	$215.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.11 / $50.02 / $56.84	Professional	26	$17.11	$50.02	$56.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.21 / $139.91 / $159.00	Professional	TC	$39.21	$139.91	$159.00
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $70.00 / $70.00 / $353.00	Facility	26	$70.00	$70.00	$353.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $181.68 / $329.41 / $699.90	Facility	TC	$181.68	$329.41	$699.90
Medica Facility/Professional Professional Modifier Low / Median / High Price $53.66 / $125.80 / $345.18	Professional		$53.66	$125.80	$345.18
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $16.73 / $38.20 / $89.67	Professional	26	$16.73	$38.20	$89.67
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $37.75 / $88.02 / $255.46	Professional	TC	$37.75	$88.02	$255.46
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.34 / $33.89 / $74.33	Professional		$19.34	$33.89	$74.33
Quartz Facility/Professional Professional Modifier Low / Median / High Price $64.34 / $127.79 / $209.09	Professional		$64.34	$127.79	$209.09
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $33.97 / $70.00 / $70.00	Facility	26	$33.97	$70.00	$70.00
Quartz Facility/Professional Facility Modifier TC Low / Median / High Price $95.05 / $181.68 / $181.68	Facility	TC	$95.05	$181.68	$181.68
Quartz Facility/Professional Professional Modifier Low / Median / High Price $79.98 / $250.40 / $345.18	Professional		$79.98	$250.40	$345.18
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $21.53 / $73.45 / $89.67	Professional	26	$21.53	$73.45	$89.67
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $58.93 / $176.95 / $255.46	Professional	TC	$58.93	$176.95	$255.46
Security Health Facility/Professional Professional Modifier Low / Median / High Price $94.56 / $338.39 / $338.39	Professional		$94.56	$338.39	$338.39
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.07 / $33.02 / $67.31	Professional	26	$28.07	$33.02	$67.31
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.24 / $72.05 / $176.94	Professional	TC	$61.24	$72.05	$176.94
United Facility/Professional Professional Modifier Low / Median / High Price $52.69 / $115.36 / $219.48	Professional		$52.69	$115.36	$219.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.01 / $31.58 / $64.38	Professional	26	$16.01	$31.58	$64.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.53 / $79.44 / $150.94	Professional	TC	$37.53	$79.44	$150.94