Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $72.90 / $72.90	Facility	26	$52.48	$72.90	$72.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.17 / $155.43 / $675.20	Professional		$91.17	$155.43	$675.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.67 / $52.48 / $433.50	Professional	26	$32.67	$52.48	$433.50
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $128.30 / $633.00 / $1,539.00	Professional	50	$128.30	$633.00	$1,539.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.85 / $77.93 / $136.61	Professional	TC	$59.85	$77.93	$136.61
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.28 / $155.43 / $563.80	Professional		$100.28	$155.43	$563.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.86 / $54.84 / $189.86	Professional	26	$33.86	$54.84	$189.86
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $150.41 / $278.88 / $845.71	Professional	50	$150.41	$278.88	$845.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.42 / $102.96 / $373.73	Professional	TC	$66.42	$102.96	$373.73
CareSource Facility/Professional Professional Modifier Low / Median / High Price $37.13 / $76.20 / $126.58	Professional		$37.13	$76.20	$126.58
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.01 / $106.36 / $163.15	Facility	26	$91.01	$106.36	$163.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.90 / $361.10 / $410.34	Professional		$128.90	$361.10	$410.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.84 / $121.52 / $138.09	Professional	26	$43.84	$121.52	$138.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.05 / $239.58 / $272.25	Professional	TC	$85.05	$239.58	$272.25
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $157.44 / $157.44 / $157.44	Facility	26	$157.44	$157.44	$157.44
Medica Facility/Professional Professional Modifier Low / Median / High Price $111.04 / $212.80 / $667.61	Professional		$111.04	$212.80	$667.61
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $39.20 / $72.81 / $219.03	Professional	26	$39.20	$72.81	$219.03
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $73.25 / $137.90 / $448.58	Professional	TC	$73.25	$137.90	$448.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $38.69 / $91.34 / $197.94	Professional		$38.69	$91.34	$197.94
Quartz Facility/Professional Professional Modifier Low / Median / High Price $190.97 / $241.37 / $436.63	Professional		$190.97	$241.37	$436.63
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $82.55 / $157.44 / $157.44	Facility	26	$82.55	$157.44	$157.44
Quartz Facility/Professional Professional Modifier Low / Median / High Price $152.09 / $495.48 / $667.61	Professional		$152.09	$495.48	$667.61
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $51.19 / $179.70 / $219.03	Professional	26	$51.19	$179.70	$219.03
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $100.90 / $339.65 / $448.58	Professional	TC	$100.90	$339.65	$448.58
Security Health Facility/Professional Professional Modifier Low / Median / High Price $276.17 / $643.44 / $643.44	Professional		$276.17	$643.44	$643.44
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $89.80 / $105.65 / $198.84	Professional	26	$89.80	$105.65	$198.84
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $171.02 / $201.20 / $374.86	Professional	TC	$171.02	$201.20	$374.86
United Facility/Professional Professional Modifier Low / Median / High Price $110.67 / $197.00 / $455.21	Professional		$110.67	$197.00	$455.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.79 / $65.02 / $145.56	Professional	26	$38.79	$65.02	$145.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.81 / $128.72 / $278.51	Professional	TC	$71.81	$128.72	$278.51