Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.82 / $57.29 / $87.88	Facility	26	$49.82	$57.29	$87.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.25 / $201.03 / $325.00	Professional		$131.25	$201.03	$325.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.20 / $51.27 / $240.10	Professional	26	$32.20	$51.27	$240.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.82 / $133.61 / $250.03	Professional	TC	$96.82	$133.61	$250.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $73.44 / $73.44 / $814.81	Professional		$73.44	$73.44	$814.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.60 / $22.60 / $206.46	Professional	26	$22.60	$22.60	$206.46
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $54.86 / $54.86 / $615.13	Professional	TC	$54.86	$54.86	$615.13
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.40 / $124.33 / $194.64	Professional		$39.40	$124.33	$194.64
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $111.74 / $130.58 / $210.61	Facility	26	$111.74	$130.58	$210.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.01 / $289.26 / $566.09	Professional		$84.01	$289.26	$566.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.37 / $67.55 / $134.94	Professional	26	$21.37	$67.55	$134.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.40 / $221.71 / $431.14	Professional	TC	$61.40	$221.71	$431.14
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $239.31 / $239.31 / $239.31	Facility	26	$239.31	$239.31	$239.31
Medica Facility/Professional Professional Modifier Low / Median / High Price $131.61 / $175.38 / $1,140.80	Professional		$131.61	$175.38	$1,140.80
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $35.72 / $57.78 / $326.98	Professional	26	$35.72	$57.78	$326.98
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $90.04 / $130.72 / $871.18	Professional	TC	$90.04	$130.72	$871.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $118.00 / $324.69	Professional		$50.00	$118.00	$324.69
Quartz Facility/Professional Professional Modifier Low / Median / High Price $196.33 / $402.62 / $574.20	Professional		$196.33	$402.62	$574.20
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $101.53 / $239.31 / $239.31	Facility	26	$101.53	$239.31	$239.31
Quartz Facility/Professional Professional Modifier Low / Median / High Price $85.05 / $876.90 / $1,140.80	Professional		$85.05	$876.90	$1,140.80
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $20.28 / $285.41 / $326.98	Professional	26	$20.28	$285.41	$326.98
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $64.78 / $653.60 / $871.18	Professional	TC	$64.78	$653.60	$871.18
Security Health Facility/Professional Professional Modifier Low / Median / High Price $180.25 / $502.03 / $913.62	Professional		$180.25	$502.03	$913.62
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.97 / $33.97 / $131.71	Professional	26	$33.97	$33.97	$131.71
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.59 / $95.59 / $387.49	Professional	TC	$95.59	$95.59	$387.49
United Facility/Professional Professional Modifier Low / Median / High Price $106.25 / $172.74 / $491.65	Professional		$106.25	$172.74	$491.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.85 / $44.66 / $145.03	Professional	26	$32.85	$44.66	$145.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.48 / $125.02 / $376.47	Professional	TC	$81.48	$125.02	$376.47