Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.49 / $12.49 / $42.39	Facility	26	$12.49	$12.49	$42.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.08 / $138.09 / $556.65	Professional		$85.08	$138.09	$556.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.17 / $17.12 / $123.25	Professional	26	$11.17	$17.12	$123.25
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $37.93 / $45.86 / $292.64	Professional	52	$37.93	$45.86	$292.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.47 / $108.84 / $252.79	Professional	TC	$67.47	$108.84	$252.79
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.66 / $142.93 / $497.20	Professional		$83.66	$142.93	$497.20
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.55 / $20.54 / $72.55	Professional	26	$11.55	$20.54	$72.55
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $71.52 / $122.46 / $423.56	Professional	TC	$71.52	$122.46	$423.56
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.70 / $72.98 / $98.70	Professional		$11.70	$72.98	$98.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.74 / $34.75 / $53.31	Facility	26	$29.74	$34.75	$53.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.75 / $207.42 / $235.70	Professional		$91.75	$207.42	$235.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.72 / $28.93 / $32.88	Professional	26	$13.72	$28.93	$32.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $78.22 / $178.49 / $202.83	Professional	TC	$78.22	$178.49	$202.83
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $125.86 / $125.86 / $237.00	Facility	26	$125.86	$125.86	$237.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $106.31 / $185.11 / $768.54	Professional		$106.31	$185.11	$768.54
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.96 / $25.37 / $267.48	Professional	26	$13.96	$25.37	$267.48
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $91.27 / $159.81 / $698.48	Professional	TC	$91.27	$159.81	$698.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $39.42 / $99.27 / $147.33	Professional		$39.42	$99.27	$147.33
Quartz Facility/Professional Professional Modifier Low / Median / High Price $152.90 / $233.24 / $395.34	Professional		$152.90	$233.24	$395.34
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $125.86 / $125.86	Facility	26	$100.00	$125.86	$125.86
Quartz Facility/Professional Professional Modifier Low / Median / High Price $93.60 / $451.62 / $768.54	Professional		$93.60	$451.62	$768.54
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $13.06 / $104.31 / $267.48	Professional	26	$13.06	$104.31	$267.48
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $80.54 / $403.31 / $698.48	Professional	TC	$80.54	$403.31	$698.48
Security Health Facility/Professional Professional Modifier Low / Median / High Price $196.86 / $418.95 / $418.95	Professional		$196.86	$418.95	$418.95
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.89 / $36.09 / $113.19	Professional	26	$30.89	$36.09	$113.19
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.67 / $186.21 / $244.74	Professional	TC	$83.67	$186.21	$244.74
United Facility/Professional Professional Modifier Low / Median / High Price $99.61 / $164.44 / $315.63	Professional		$99.61	$164.44	$315.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.64 / $24.29 / $45.41	Professional	26	$13.64	$24.29	$45.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.91 / $145.22 / $268.87	Professional	TC	$85.91	$145.22	$268.87