Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.44 / $85.32 / $86.01	Facility	26	$61.44	$85.32	$86.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.71 / $295.37 / $662.00	Professional		$102.71	$295.37	$662.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.96 / $153.00 / $427.50	Professional	26	$37.96	$153.00	$427.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.82 / $82.38 / $411.84	Professional	TC	$56.82	$82.38	$411.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $106.71 / $165.59 / $604.66	Professional		$106.71	$165.59	$604.66
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.64 / $65.97 / $230.93	Professional	26	$39.64	$65.97	$230.93
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.06 / $103.95 / $380.49	Professional	TC	$67.06	$103.95	$380.49
CareSource Facility/Professional Professional Modifier Low / Median / High Price $43.30 / $79.30 / $132.88	Professional		$43.30	$79.30	$132.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.13 / $126.36 / $193.85	Facility	26	$108.13	$126.36	$193.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $121.80 / $389.07 / $442.13	Professional		$121.80	$389.07	$442.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.06 / $143.63 / $163.22	Professional	26	$49.06	$143.63	$163.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $73.65 / $245.43 / $278.89	Professional	TC	$73.65	$245.43	$278.89
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $181.68 / $181.68 / $184.00	Facility	26	$181.68	$181.68	$184.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $117.23 / $259.89 / $708.49	Professional		$117.23	$259.89	$708.49
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $45.77 / $104.82 / $257.68	Professional	26	$45.77	$104.82	$257.68
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $71.81 / $140.30 / $450.80	Professional	TC	$71.81	$140.30	$450.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.36 / $98.65 / $191.96	Professional		$41.36	$98.65	$191.96
Quartz Facility/Professional Professional Modifier Low / Median / High Price $202.83 / $257.39 / $470.45	Professional		$202.83	$257.39	$470.45
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $181.68 / $181.68	Facility	26	$100.00	$181.68	$181.68
Quartz Facility/Professional Professional Modifier Low / Median / High Price $163.86 / $549.54 / $708.49	Professional		$163.86	$549.54	$708.49
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $60.49 / $209.90 / $257.68	Professional	26	$60.49	$209.90	$257.68
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $103.37 / $339.65 / $450.80	Professional	TC	$103.37	$339.65	$450.80
Security Health Facility/Professional Professional Modifier Low / Median / High Price $208.85 / $693.24 / $693.24	Professional		$208.85	$693.24	$693.24
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $100.14 / $126.71 / $235.30	Professional	26	$100.14	$126.71	$235.30
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.10 / $205.22 / $435.03	Professional	TC	$97.10	$205.22	$435.03
United Facility/Professional Professional Modifier Low / Median / High Price $115.13 / $207.61 / $481.68	Professional		$115.13	$207.61	$481.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.61 / $86.64 / $183.98	Professional	26	$44.61	$86.64	$183.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.81 / $130.11 / $278.51	Professional	TC	$71.81	$130.11	$278.51