Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.90 / $74.63 / $90.16	Facility	26	$64.90	$74.63	$90.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.69 / $124.24 / $602.00	Professional		$51.69	$124.24	$602.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.02 / $50.94 / $178.50	Professional	26	$25.02	$50.94	$178.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $11.50 / $24.57 / $138.78	Professional	TC	$11.50	$24.57	$138.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.28 / $120.47 / $384.82	Professional		$52.28	$120.47	$384.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.36 / $64.90 / $197.75	Professional	26	$31.36	$64.90	$197.75
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $78.42 / $183.25 / $577.23	Professional	50	$78.42	$183.25	$577.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $10.41 / $55.31 / $214.03	Professional	TC	$10.41	$55.31	$214.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $10.81 / $49.28 / $69.13	Professional		$10.81	$49.28	$69.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $113.54 / $132.68 / $203.54	Facility	26	$113.54	$132.68	$203.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $80.19 / $189.64 / $215.50	Professional		$80.19	$189.64	$215.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.36 / $151.72 / $172.43	Professional	26	$37.36	$151.72	$172.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.23 / $37.90 / $96.51	Professional	TC	$16.23	$37.90	$96.51
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $193.75 / $193.75 / $193.75	Facility	26	$193.75	$193.75	$193.75
Medica Facility/Professional Professional Modifier Low / Median / High Price $90.59 / $199.41 / $558.63	Professional		$90.59	$199.41	$558.63
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $33.99 / $63.20 / $260.82	Professional	26	$33.99	$63.20	$260.82
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $50.86 / $120.05 / $430.88	Professional	TC	$50.86	$120.05	$430.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $38.63 / $68.40 / $139.02	Professional		$38.63	$68.40	$139.02
Quartz Facility/Professional Professional Modifier Low / Median / High Price $100.10 / $152.32 / $277.83	Professional		$100.10	$152.32	$277.83
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $103.08 / $193.75 / $193.75	Facility	26	$103.08	$193.75	$193.75
Quartz Facility/Professional Professional Modifier Low / Median / High Price $79.88 / $377.45 / $558.63	Professional		$79.88	$377.45	$558.63
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $39.79 / $185.54 / $260.82	Professional	26	$39.79	$185.54	$260.82
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $15.97 / $221.50 / $430.88	Professional	TC	$15.97	$221.50	$430.88
Security Health Facility/Professional Professional Modifier Low / Median / High Price $287.33 / $337.92 / $427.71	Professional		$287.33	$337.92	$427.71
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $84.97 / $91.66 / $172.66	Professional	26	$84.97	$91.66	$172.66
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $162.88 / $246.37 / $515.79	Professional	TC	$162.88	$246.37	$515.79
United Facility/Professional Professional Modifier Low / Median / High Price $79.04 / $173.33 / $330.83	Professional		$79.04	$173.33	$330.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.54 / $95.00 / $224.38	Professional	26	$43.54	$95.00	$224.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.84 / $114.29 / $238.07	Professional	TC	$39.84	$114.29	$238.07