Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.45 / $84.45 / $84.45	Facility	26	$84.45	$84.45	$84.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $94.38 / $116.05 / $424.14	Professional		$94.38	$116.05	$424.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.04 / $84.45 / $286.88	Professional	26	$71.04	$84.45	$286.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.69 / $32.81 / $128.52	Professional	TC	$19.69	$32.81	$128.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.80 / $219.38 / $464.84	Professional		$104.80	$219.38	$464.84
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $78.04 / $162.19 / $350.03	Professional	26	$78.04	$162.19	$350.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $24.40 / $60.74 / $121.47	Professional	TC	$24.40	$60.74	$121.47
CareSource Facility/Professional Professional Modifier Low / Median / High Price $25.81 / $71.20 / $97.01	Professional		$25.81	$71.20	$97.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $205.46 / $240.09 / $272.83	Facility	26	$205.46	$240.09	$272.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.50 / $233.84 / $313.16	Professional		$114.50	$233.84	$313.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.12 / $175.99 / $225.95	Professional	26	$83.12	$175.99	$225.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.40 / $62.30 / $88.90	Professional	TC	$30.40	$62.30	$88.90
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $177.91 / $343.65 / $343.65	Facility	26	$177.91	$343.65	$343.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $95.96 / $147.03 / $422.04	Professional		$95.96	$147.03	$422.04
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $73.29 / $114.42 / $317.58	Professional	26	$73.29	$114.42	$317.58
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $19.71 / $33.74 / $102.27	Professional	TC	$19.71	$33.74	$102.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.40 / $94.53 / $247.51	Professional		$30.40	$94.53	$247.51
Quartz Facility/Professional Professional Modifier Low / Median / High Price $130.25 / $242.19 / $340.96	Professional		$130.25	$242.19	$340.96
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $156.13 / $177.91 / $343.65	Facility	26	$156.13	$177.91	$343.65
Quartz Facility/Professional Professional Modifier Low / Median / High Price $135.53 / $527.60 / $702.18	Professional		$135.53	$527.60	$702.18
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $97.00 / $395.15 / $487.97	Professional	26	$97.00	$395.15	$487.97
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $38.54 / $167.80 / $214.27	Professional	TC	$38.54	$167.80	$214.27
Security Health Facility/Professional Professional Modifier Low / Median / High Price $31.98 / $555.66 / $555.66	Professional		$31.98	$555.66	$555.66
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.46 / $179.95 / $236.60	Professional	26	$97.46	$179.95	$236.60
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.86 / $48.82 / $74.43	Professional	TC	$40.86	$48.82	$74.43
United Facility/Professional Professional Modifier Low / Median / High Price $94.77 / $142.66 / $344.00	Professional		$94.77	$142.66	$344.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $73.00 / $117.98 / $276.61	Professional	26	$73.00	$117.98	$276.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.41 / $40.79 / $89.21	Professional	TC	$23.41	$40.79	$89.21