Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.79 / $30.79 / $30.79	Facility	26	$30.79	$30.79	$30.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $68.06 / $111.30 / $309.82	Professional		$68.06	$111.30	$309.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.57 / $30.51 / $77.00	Professional	26	$19.57	$30.51	$77.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.22 / $77.19 / $103.58	Professional	TC	$50.22	$77.19	$103.58
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $71.80 / $147.41 / $449.20	Professional		$71.80	$147.41	$449.20
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.87 / $40.33 / $125.09	Professional	26	$19.87	$40.33	$125.09
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.94 / $107.11 / $324.11	Professional	TC	$51.94	$107.11	$324.11
CareSource Facility/Professional Professional Modifier Low / Median / High Price $27.02 / $66.02 / $93.03	Professional		$27.02	$66.02	$93.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.97 / $64.23 / $98.54	Facility	26	$54.97	$64.23	$98.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.55 / $264.72 / $300.81	Professional		$67.55	$264.72	$300.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.45 / $72.02 / $81.84	Professional	26	$18.45	$72.02	$81.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.10 / $192.65 / $218.93	Professional	TC	$49.10	$192.65	$218.93
Medica Facility/Professional Professional Modifier Low / Median / High Price $86.14 / $197.48 / $468.55	Professional		$86.14	$197.48	$468.55
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $22.42 / $48.43 / $126.27	Professional	26	$22.42	$48.43	$126.27
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $63.01 / $142.30 / $342.28	Professional	TC	$63.01	$142.30	$342.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $39.42 / $90.17 / $140.63	Professional		$39.42	$90.17	$140.63
Quartz Facility/Professional Professional Modifier Low / Median / High Price $141.66 / $179.78 / $320.08	Professional		$141.66	$179.78	$320.08
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $104.06 / $104.06 / $104.06	Facility	26	$104.06	$104.06	$104.06
Quartz Facility/Professional Professional Modifier Low / Median / High Price $67.55 / $364.35 / $468.55	Professional		$67.55	$364.35	$468.55
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $18.45 / $101.80 / $126.27	Professional	26	$18.45	$101.80	$126.27
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $49.10 / $262.60 / $342.28	Professional	TC	$49.10	$262.60	$342.28
United Facility/Professional Professional Modifier Low / Median / High Price $80.90 / $192.49 / $343.73	Professional		$80.90	$192.49	$343.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.28 / $46.49 / $91.61	Professional	26	$22.28	$46.49	$91.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.76 / $131.88 / $272.20	Professional	TC	$57.76	$131.88	$272.20