Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.29 / $39.43 / $39.43	Facility	26	$34.29	$39.43	$39.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.70 / $65.52 / $140.16	Professional		$56.70	$65.52	$140.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.17 / $40.01 / $146.30	Professional	26	$31.17	$40.01	$146.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.60 / $25.10 / $38.76	Professional	TC	$21.60	$25.10	$38.76
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.40 / $122.52 / $205.98	Professional		$63.40	$122.52	$205.98
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.10 / $71.44 / $122.27	Professional	26	$38.10	$71.44	$122.27
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.30 / $50.15 / $85.14	Professional	TC	$25.30	$50.15	$85.14
CareSource Facility/Professional Professional Modifier Low / Median / High Price $24.31 / $34.11 / $58.42	Professional		$24.31	$34.11	$58.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.22 / $114.78 / $130.43	Facility	26	$98.22	$114.78	$130.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.84 / $128.87 / $158.40	Professional		$69.84	$128.87	$158.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.33 / $74.48 / $90.98	Professional	26	$40.33	$74.48	$90.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $54.36 / $66.01	Professional	TC	$30.20	$54.36	$66.01
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $84.68 / $165.02 / $165.02	Facility	26	$84.68	$165.02	$165.02
Medica Facility/Professional Professional Modifier Low / Median / High Price $55.06 / $80.75 / $265.64	Professional		$55.06	$80.75	$265.64
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $34.50 / $49.19 / $148.88	Professional	26	$34.50	$49.19	$148.88
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $22.08 / $32.47 / $96.50	Professional	TC	$22.08	$32.47	$96.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.84 / $58.40 / $126.60	Professional		$25.84	$58.40	$126.60
Quartz Facility/Professional Professional Modifier Low / Median / High Price $47.10 / $145.68 / $206.62	Professional		$47.10	$145.68	$206.62
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $74.87 / $84.68 / $165.02	Facility	26	$74.87	$84.68	$165.02
Quartz Facility/Professional Professional Modifier Low / Median / High Price $113.06 / $310.60 / $396.08	Professional		$113.06	$310.60	$396.08
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $68.43 / $188.45 / $347.34	Professional	26	$68.43	$188.45	$347.34
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $45.35 / $122.15 / $166.53	Professional	TC	$45.35	$122.15	$166.53
Security Health Facility/Professional Professional Modifier Low / Median / High Price $67.12 / $226.18 / $226.18	Professional		$67.12	$226.18	$226.18
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.34 / $59.62 / $111.25	Professional	26	$50.34	$59.62	$111.25
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.89 / $39.86 / $75.93	Professional	TC	$33.89	$39.86	$75.93
United Facility/Professional Professional Modifier Low / Median / High Price $55.20 / $78.91 / $158.58	Professional		$55.20	$78.91	$158.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.47 / $46.46 / $96.22	Professional	26	$34.47	$46.46	$96.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.20 / $33.58 / $57.75	Professional	TC	$22.20	$33.58	$57.75