Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.45 / $43.15 / $59.72	Facility	26	$30.45	$43.15	$59.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.93 / $79.08 / $255.00	Professional		$49.93	$79.08	$255.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.99 / $57.95 / $156.55	Professional	26	$26.99	$57.95	$156.55
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $22.94 / $57.49 / $285.00	Professional	52	$22.94	$57.49	$285.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.68 / $37.50 / $128.63	Professional	TC	$22.68	$37.50	$128.63
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.36 / $92.01 / $254.82	Professional		$48.36	$92.01	$254.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.60 / $50.02 / $139.47	Professional	26	$27.60	$50.02	$139.47
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.03 / $41.99 / $114.10	Professional	TC	$23.03	$41.99	$114.10
CareSource Facility/Professional Professional Modifier Low / Median / High Price $25.76 / $36.29 / $75.15	Professional		$25.76	$36.29	$75.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.79 / $89.54 / $116.16	Facility	26	$78.79	$89.54	$116.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.69 / $183.76 / $208.81	Professional		$62.69	$183.76	$208.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.51 / $99.33 / $112.88	Professional	26	$33.51	$99.33	$112.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.18 / $84.43 / $95.94	Professional	TC	$29.18	$84.43	$95.94
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $31.76 / $128.65 / $128.65	Facility	26	$31.76	$128.65	$128.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $61.00 / $123.07 / $334.42	Professional		$61.00	$123.07	$334.42
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $33.71 / $62.00 / $182.49	Professional	26	$33.71	$62.00	$182.49
Medica Facility/Professional Professional Modifier 52 Low / Median / High Price $41.80 / $41.80 / $74.93	Professional	52	$41.80	$41.80	$74.93
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $27.32 / $57.77 / $151.88	Professional	TC	$27.32	$57.77	$151.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $23.68 / $55.81 / $125.50	Professional		$23.68	$55.81	$125.50
Quartz Facility/Professional Professional Modifier Low / Median / High Price $102.05 / $123.84 / $222.19	Professional		$102.05	$123.84	$222.19
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $67.48 / $128.65 / $128.65	Facility	26	$67.48	$128.65	$128.65
Quartz Facility/Professional Professional Modifier Low / Median / High Price $80.48 / $267.55 / $334.42	Professional		$80.48	$267.55	$334.42
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $44.04 / $147.69 / $182.49	Professional	26	$44.04	$147.69	$182.49
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $36.40 / $119.85 / $151.88	Professional	TC	$36.40	$119.85	$151.88
Security Health Facility/Professional Professional Modifier Low / Median / High Price $67.50 / $327.39 / $327.39	Professional		$67.50	$327.39	$327.39
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $62.08 / $66.40 / $99.86	Professional	26	$62.08	$66.40	$99.86
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.55 / $66.87 / $84.88	Professional	TC	$50.55	$66.87	$84.88
United Facility/Professional Professional Modifier Low / Median / High Price $75.64 / $152.35 / $411.72	Professional		$75.64	$152.35	$411.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.56 / $70.00 / $129.46	Professional	26	$33.56	$70.00	$129.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.35 / $59.85 / $105.05	Professional	TC	$26.35	$59.85	$105.05