Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.69 / $84.69 / $292.29	Facility	26	$84.69	$84.69	$292.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $133.78 / $217.46 / $943.50	Professional		$133.78	$217.46	$943.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.04 / $90.03 / $392.78	Professional	26	$72.04	$90.03	$392.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.59 / $63.56 / $103.58	Professional	TC	$51.59	$63.56	$103.58
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $130.87 / $191.63 / $533.19	Professional		$130.87	$191.63	$533.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.61 / $111.91 / $300.69	Professional	26	$75.61	$111.91	$300.69
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $56.06 / $79.73 / $233.68	Professional	TC	$56.06	$79.73	$233.68
CareSource Facility/Professional Professional Modifier Low / Median / High Price $58.53 / $89.80 / $161.63	Professional		$58.53	$89.80	$161.63
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $207.26 / $242.20 / $371.54	Facility	26	$207.26	$242.20	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $135.75 / $329.18 / $436.29	Professional		$135.75	$329.18	$436.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.01 / $198.90 / $255.20	Professional	26	$93.01	$198.90	$255.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $71.97 / $143.46 / $195.99	Professional	TC	$71.97	$143.46	$195.99
Medica Facility/Professional Professional Modifier Low / Median / High Price $170.74 / $342.34 / $874.03	Professional		$170.74	$342.34	$874.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $97.18 / $196.68 / $497.06	Professional	26	$97.18	$196.68	$497.06
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $78.44 / $149.41 / $376.97	Professional	TC	$78.44	$149.41	$376.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $57.62 / $118.13 / $251.00	Professional		$57.62	$118.13	$251.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $214.38 / $306.20 / $436.70	Professional		$214.38	$306.20	$436.70
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $351.19 / $351.19 / $351.19	Facility	26	$351.19	$351.19	$351.19
Quartz Facility/Professional Professional Modifier Low / Median / High Price $194.16 / $711.40 / $874.03	Professional		$194.16	$711.40	$874.03
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $112.80 / $400.90 / $497.06	Professional	26	$112.80	$400.90	$497.06
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $81.34 / $310.55 / $376.97	Professional	TC	$81.34	$310.55	$376.97
Security Health Facility/Professional Professional Modifier Low / Median / High Price $196.86 / $557.64 / $691.51	Professional		$196.86	$557.64	$691.51
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $98.68 / $202.51 / $256.24	Professional	26	$98.68	$202.51	$256.24
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.04 / $167.11 / $211.44	Professional	TC	$72.04	$167.11	$211.44
United Facility/Professional Professional Modifier Low / Median / High Price $169.29 / $294.52 / $546.96	Professional		$169.29	$294.52	$546.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.13 / $163.98 / $300.68	Professional	26	$95.13	$163.98	$300.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $70.88 / $129.11 / $239.76	Professional	TC	$70.88	$129.11	$239.76