Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.87 / $14.80 / $44.07	Facility	26	$12.87	$14.80	$44.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.71 / $58.98 / $261.00	Professional		$50.71	$58.98	$261.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.08 / $15.15 / $67.51	Professional	26	$11.08	$15.15	$67.51
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.93 / $28.14 / $36.45	Professional	52	$24.93	$28.14	$36.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.11 / $45.31 / $84.25	Professional	TC	$39.11	$45.31	$84.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.86 / $76.88 / $182.34	Professional		$51.86	$76.88	$182.34
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.49 / $17.01 / $39.52	Professional	26	$11.49	$17.01	$39.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.72 / $59.87 / $140.13	Professional	TC	$39.72	$59.87	$140.13
CareSource Facility/Professional Professional Modifier Low / Median / High Price $12.62 / $47.98 / $69.50	Professional		$12.62	$47.98	$69.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.64 / $35.79 / $54.92	Facility	26	$30.64	$35.79	$54.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.63 / $135.99 / $160.96	Professional		$63.63	$135.99	$160.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.11 / $28.05 / $34.18	Professional	26	$14.11	$28.05	$34.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.55 / $108.95 / $126.76	Professional	TC	$49.55	$108.95	$126.76
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $27.92 / $80.00 / $130.33	Facility	26	$27.92	$80.00	$130.33
Medica Facility/Professional Professional Modifier Low / Median / High Price $54.50 / $92.52 / $346.85	Professional		$54.50	$92.52	$346.85
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $12.63 / $21.68 / $74.58	Professional	26	$12.63	$21.68	$74.58
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $41.87 / $70.06 / $272.27	Professional	TC	$41.87	$70.06	$272.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.71 / $46.76 / $71.36	Professional		$19.71	$46.76	$71.36
Quartz Facility/Professional Professional Modifier Low / Median / High Price $93.50 / $131.12 / $187.00	Professional		$93.50	$131.12	$187.00
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $13.55 / $80.00 / $80.00	Facility	26	$13.55	$80.00	$80.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $70.84 / $258.70 / $346.85	Professional		$70.84	$258.70	$346.85
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $17.64 / $61.20 / $74.58	Professional	26	$17.64	$61.20	$74.58
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $55.19 / $197.50 / $272.27	Professional	TC	$55.19	$197.50	$272.27
Security Health Facility/Professional Facility Modifier 26 Low / Median / High Price $19.73 / $19.73 / $19.73	Facility	26	$19.73	$19.73	$19.73
Security Health Facility/Professional Professional Modifier Low / Median / High Price $71.87 / $181.14 / $196.19	Professional		$71.87	$181.14	$196.19
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.78 / $19.35 / $28.28	Professional	26	$16.78	$19.35	$28.28
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.64 / $64.56 / $104.88	Professional	TC	$51.64	$64.56	$104.88
United Facility/Professional Professional Modifier Low / Median / High Price $65.43 / $124.56 / $247.63	Professional		$65.43	$124.56	$247.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.63 / $22.64 / $90.00	Professional	26	$12.63	$22.64	$90.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.39 / $66.27 / $134.78	Professional	TC	$41.39	$66.27	$134.78