Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.48 / $22.40 / $27.07	Facility	26	$19.48	$22.40	$27.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.74 / $56.54 / $275.32	Professional		$38.74	$56.54	$275.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.56 / $19.48 / $101.47	Professional	26	$12.56	$19.48	$101.47
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $19.37 / $23.56 / $45.35	Professional	52	$19.37	$23.56	$45.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.97 / $34.61 / $63.17	Professional	TC	$23.97	$34.61	$63.17
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.01 / $87.34 / $245.74	Professional		$38.01	$87.34	$245.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.56 / $29.01 / $80.81	Professional	26	$12.56	$29.01	$80.81
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.53 / $61.29 / $175.11	Professional	TC	$23.53	$61.29	$175.11
CareSource Facility/Professional Professional Modifier Low / Median / High Price $14.40 / $38.64 / $61.19	Professional		$14.40	$38.64	$61.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.24 / $40.02 / $53.18	Facility	26	$34.24	$40.02	$53.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.58 / $158.50 / $180.11	Professional		$45.58	$158.50	$180.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.02 / $45.56 / $51.78	Professional	26	$14.02	$45.56	$51.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.22 / $112.95 / $128.35	Professional	TC	$32.22	$112.95	$128.35
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $80.00 / $80.00 / $80.00	Facility	26	$80.00	$80.00	$80.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $44.90 / $105.18 / $290.45	Professional		$44.90	$105.18	$290.45
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $15.26 / $33.71 / $82.68	Professional	26	$15.26	$33.71	$82.68
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $30.62 / $71.47 / $207.72	Professional	TC	$30.62	$71.47	$207.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.34 / $43.33 / $74.33	Professional		$19.34	$43.33	$74.33
Quartz Facility/Professional Professional Modifier Low / Median / High Price $56.39 / $107.28 / $154.44	Professional		$56.39	$107.28	$154.44
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $30.95 / $80.00 / $80.00	Facility	26	$30.95	$80.00	$80.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $66.76 / $211.35 / $290.45	Professional		$66.76	$211.35	$290.45
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $20.52 / $66.90 / $82.68	Professional	26	$20.52	$66.90	$82.68
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $47.57 / $144.44 / $207.72	Professional	TC	$47.57	$144.44	$207.72
Security Health Facility/Professional Professional Modifier Low / Median / High Price $122.09 / $282.45 / $282.45	Professional		$122.09	$282.45	$282.45
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.52 / $79.65 / $107.73	Professional	26	$45.52	$79.65	$107.73
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.79 / $155.41 / $196.64	Professional	TC	$69.79	$155.41	$196.64
United Facility/Professional Professional Modifier Low / Median / High Price $44.75 / $97.37 / $185.25	Professional		$44.75	$97.37	$185.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.25 / $66.23 / $102.97	Professional	26	$22.25	$66.23	$102.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.91 / $95.00 / $199.10	Professional	TC	$46.91	$95.00	$199.10