Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.53 / $19.53 / $68.17	Facility	26	$19.53	$19.53	$68.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.52 / $88.12 / $615.60	Professional		$54.52	$88.12	$615.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.39 / $20.37 / $123.50	Professional	26	$16.39	$20.37	$123.50
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $29.00 / $29.00 / $29.00	Professional	50	$29.00	$29.00	$29.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $27.13 / $33.57 / $54.62	Professional	52	$27.13	$33.57	$54.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.11 / $47.59 / $78.78	Professional	TC	$38.11	$47.59	$78.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.52 / $88.70 / $270.33	Professional		$57.52	$88.70	$270.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.29 / $25.81 / $79.54	Professional	26	$17.29	$25.81	$79.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.93 / $62.89 / $190.47	Professional	TC	$38.93	$62.89	$190.47
CareSource Facility/Professional Professional Modifier Low / Median / High Price $20.22 / $44.74 / $73.05	Professional		$20.22	$44.74	$73.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.76 / $55.81 / $85.61	Facility	26	$47.76	$55.81	$85.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $68.22 / $157.50 / $197.92	Professional		$68.22	$157.50	$197.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.69 / $46.51 / $59.64	Professional	26	$21.69	$46.51	$59.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.30 / $110.97 / $141.41	Professional	TC	$48.30	$110.97	$141.41
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $156.00 / $156.00 / $156.00	Facility	26	$156.00	$156.00	$156.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $70.52 / $146.50 / $415.00	Professional		$70.52	$146.50	$415.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $22.29 / $45.98 / $115.58	Professional	26	$22.29	$45.98	$115.58
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $49.76 / $101.93 / $299.48	Professional	TC	$49.76	$101.93	$299.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $20.68 / $50.46 / $74.44	Professional		$20.68	$50.46	$74.44
Quartz Facility/Professional Professional Modifier Low / Median / High Price $96.66 / $138.06 / $196.90	Professional		$96.66	$138.06	$196.90
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $81.76 / $81.76 / $81.76	Facility	26	$81.76	$81.76	$81.76
Quartz Facility/Professional Professional Modifier Low / Median / High Price $89.06 / $305.20 / $415.00	Professional		$89.06	$305.20	$415.00
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $26.38 / $92.85 / $115.58	Professional	26	$26.38	$92.85	$115.58
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $62.04 / $212.35 / $299.48	Professional	TC	$62.04	$212.35	$299.48
Security Health Facility/Professional Professional Modifier Low / Median / High Price $88.59 / $258.32 / $318.10	Professional		$88.59	$258.32	$318.10
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.05 / $47.37 / $59.94	Professional	26	$23.05	$47.37	$59.94
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.36 / $97.24 / $127.22	Professional	TC	$57.36	$97.24	$127.22
United Facility/Professional Professional Modifier Low / Median / High Price $68.50 / $122.43 / $228.90	Professional		$68.50	$122.43	$228.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.57 / $38.28 / $69.64	Professional	26	$21.57	$38.28	$69.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.15 / $102.19 / $154.09	Professional	TC	$48.15	$102.19	$154.09