Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.88 / $69.05 / $69.83	Facility	26	$49.88	$69.05	$69.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.62 / $330.24 / $803.25	Professional		$114.62	$330.24	$803.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.58 / $82.45 / $335.04	Professional	26	$31.58	$82.45	$335.04
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $52.38 / $90.14 / $273.00	Professional	52	$52.38	$90.14	$273.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.78 / $130.40 / $529.91	Professional	TC	$77.78	$130.40	$529.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $116.31 / $180.28 / $678.21	Professional		$116.31	$180.28	$678.21
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.18 / $52.20 / $187.87	Professional	26	$32.18	$52.20	$187.87
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $84.13 / $130.40 / $491.69	Professional	TC	$84.13	$130.40	$491.69
CareSource Facility/Professional Professional Modifier Low / Median / High Price $35.11 / $94.71 / $145.15	Professional		$35.11	$94.71	$145.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.51 / $101.09 / $155.08	Facility	26	$86.51	$101.09	$155.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $130.66 / $419.50 / $476.70	Professional		$130.66	$419.50	$476.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.60 / $115.04 / $130.72	Professional	26	$39.60	$115.04	$130.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.72 / $304.45 / $345.98	Professional	TC	$91.72	$304.45	$345.98
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $119.81 / $148.36 / $245.10	Facility	26	$119.81	$148.36	$245.10
Medica Facility/Professional Professional Modifier Low / Median / High Price $125.23 / $281.77 / $778.42	Professional		$125.23	$281.77	$778.42
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $37.36 / $90.24 / $290.60	Professional	26	$37.36	$90.24	$290.60
Medica Facility/Professional Professional Modifier 52 Low / Median / High Price $113.60 / $113.60 / $113.60	Professional	52	$113.60	$113.60	$113.60
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $88.79 / $172.65 / $570.15	Professional	TC	$88.79	$172.65	$570.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $57.01 / $126.44 / $253.98	Professional		$57.01	$126.44	$253.98
Quartz Facility/Professional Professional Modifier Low / Median / High Price $220.31 / $334.00 / $529.50	Professional		$220.31	$334.00	$529.50
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $148.36 / $148.36	Facility	26	$100.00	$148.36	$148.36
Quartz Facility/Professional Professional Modifier Low / Median / High Price $176.69 / $596.04 / $778.42	Professional		$176.69	$596.04	$778.42
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $48.46 / $170.80 / $290.60	Professional	26	$48.46	$170.80	$290.60
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $128.22 / $425.25 / $570.15	Professional	TC	$128.22	$425.25	$570.15
Security Health Facility/Professional Professional Modifier Low / Median / High Price $319.47 / $747.50 / $747.50	Professional		$319.47	$747.50	$747.50
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $100.45 / $127.10 / $188.97	Professional	26	$100.45	$127.10	$188.97
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $172.97 / $249.38 / $315.54	Professional	TC	$172.97	$249.38	$315.54
United Facility/Professional Professional Modifier Low / Median / High Price $86.60 / $169.02 / $755.80	Professional		$86.60	$169.02	$755.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.86 / $65.64 / $138.35	Professional	26	$35.86	$65.64	$138.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $88.79 / $159.29 / $372.73	Professional	TC	$88.79	$159.29	$372.73