Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.75 / $63.32 / $64.04	Facility	26	$45.75	$63.32	$64.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $96.70 / $176.94 / $775.80	Professional		$96.70	$176.94	$775.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.91 / $72.41 / $323.00	Professional	26	$28.91	$72.41	$323.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.94 / $105.25 / $418.95	Professional	TC	$60.94	$105.25	$418.95
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.87 / $151.69 / $562.79	Professional		$97.87	$151.69	$562.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.52 / $48.05 / $172.82	Professional	26	$29.52	$48.05	$172.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $68.36 / $105.95 / $382.30	Professional	TC	$68.36	$105.95	$382.30
CareSource Facility/Professional Professional Modifier Low / Median / High Price $32.22 / $77.56 / $123.26	Professional		$32.22	$77.56	$123.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.30 / $92.67 / $142.15	Facility	26	$79.30	$92.67	$142.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.24 / $352.01 / $400.01	Professional		$112.24	$352.01	$400.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.77 / $105.40 / $119.78	Professional	26	$36.77	$105.40	$119.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.70 / $246.61 / $280.24	Professional	TC	$76.70	$246.61	$280.24
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $136.22 / $136.22 / $396.00	Facility	26	$136.22	$136.22	$396.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $107.05 / $212.42 / $654.87	Professional		$107.05	$212.42	$654.87
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $34.20 / $73.08 / $217.94	Professional	26	$34.20	$73.08	$217.94
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $64.42 / $144.38 / $461.63	Professional	TC	$64.42	$144.38	$461.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.36 / $94.25 / $191.96	Professional		$41.36	$94.25	$191.96
Quartz Facility/Professional Professional Modifier Low / Median / High Price $184.55 / $282.79 / $399.71	Professional		$184.55	$282.79	$399.71
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $136.22 / $136.22	Facility	26	$100.00	$136.22	$136.22
Quartz Facility/Professional Professional Modifier Low / Median / High Price $148.26 / $508.25 / $654.87	Professional		$148.26	$508.25	$654.87
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $44.40 / $156.60 / $217.94	Professional	26	$44.40	$156.60	$217.94
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $103.86 / $351.65 / $461.63	Professional	TC	$103.86	$351.65	$461.63
Security Health Facility/Professional Professional Modifier Low / Median / High Price $195.04 / $627.24 / $627.24	Professional		$195.04	$627.24	$627.24
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.19 / $106.21 / $172.73	Professional	26	$93.19	$106.21	$172.73
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $101.84 / $136.55 / $528.96	Professional	TC	$101.84	$136.55	$528.96
United Facility/Professional Professional Modifier Low / Median / High Price $106.83 / $169.31 / $391.35	Professional		$106.83	$169.31	$391.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.61 / $59.16 / $128.41	Professional	26	$32.61	$59.16	$128.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.64 / $117.49 / $261.99	Professional	TC	$69.64	$117.49	$261.99