Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.56 / $13.29 / $16.07	Facility	26	$11.56	$13.29	$16.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.25 / $57.95 / $212.50	Professional		$25.25	$57.95	$212.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $11.56 / $68.00	Professional	26	$7.03	$11.56	$68.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $39.29 / $39.29 / $39.29	Professional	50	$39.29	$39.29	$39.29
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.41 / $21.33 / $80.87	Professional	52	$12.41	$21.33	$80.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.21 / $29.82 / $116.05	Professional	TC	$18.21	$29.82	$116.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.54 / $57.57 / $166.79	Professional		$26.54	$57.57	$166.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.46 / $17.23 / $48.00	Professional	26	$7.46	$17.23	$48.00
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $39.03 / $92.76 / $264.58	Professional	50	$39.03	$92.76	$264.58
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.42 / $41.02 / $114.81	Professional	TC	$18.42	$41.02	$114.81
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.53 / $24.72 / $38.21	Professional		$8.53	$24.72	$38.21
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.82 / $23.17 / $30.79	Facility	26	$19.82	$23.17	$30.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.68 / $100.13 / $113.79	Professional		$30.68	$100.13	$113.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.11 / $27.05 / $30.74	Professional	26	$9.11	$27.05	$30.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.21 / $73.08 / $83.05	Professional	TC	$21.21	$73.08	$83.05
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $155.00	Facility	26	$100.00	$100.00	$155.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $29.96 / $69.94 / $184.96	Professional		$29.96	$69.94	$184.96
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.07 / $20.68 / $67.13	Professional	26	$9.07	$20.68	$67.13
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $20.63 / $49.27 / $149.00	Professional	TC	$20.63	$49.27	$149.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.34 / $33.89 / $70.00	Professional		$19.34	$33.89	$70.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $55.25 / $82.77 / $121.08	Professional		$55.25	$82.77	$121.08
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 $46.39 / $134.50 / $184.96	Professional		$46.39	$134.50	$184.96
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $12.53 / $39.75 / $67.13	Professional	26	$12.53	$39.75	$67.13
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $31.88 / $94.75 / $149.00	Professional	TC	$31.88	$94.75	$149.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $57.73 / $163.25 / $178.39	Professional		$57.73	$163.25	$178.39
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.70 / $22.40 / $43.64	Professional	26	$17.70	$22.40	$43.64
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.02 / $45.52 / $119.43	Professional	TC	$40.02	$45.52	$119.43
United Facility/Professional Professional Modifier Low / Median / High Price $28.58 / $60.82 / $117.89	Professional		$28.58	$60.82	$117.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.34 / $18.18 / $34.84	Professional	26	$8.34	$18.18	$34.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.21 / $42.02 / $83.15	Professional	TC	$20.21	$42.02	$83.15