Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.06 / $85.12 / $110.68	Facility	26	$79.06	$85.12	$110.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $139.78 / $383.41 / $1,467.00	Professional		$139.78	$383.41	$1,467.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.54 / $90.22 / $472.60	Professional	26	$39.54	$90.22	$472.60
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $64.14 / $85.50 / $140.84	Professional	52	$64.14	$85.50	$140.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.27 / $177.92 / $548.41	Professional	TC	$97.27	$177.92	$548.41
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.49 / $305.52 / $1,000.81	Professional		$128.49	$305.52	$1,000.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.53 / $93.99 / $308.16	Professional	26	$39.53	$93.99	$308.16
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $88.96 / $208.79 / $692.64	Professional	TC	$88.96	$208.79	$692.64
CareSource Facility/Professional Professional Modifier Low / Median / High Price $45.20 / $107.07 / $176.63	Professional		$45.20	$107.07	$176.63
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $106.33 / $124.26 / $165.15	Facility	26	$106.33	$124.26	$165.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $187.39 / $462.56 / $525.64	Professional		$187.39	$462.56	$525.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.20 / $142.09 / $161.46	Professional	26	$55.20	$142.09	$161.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.76 / $320.45 / $364.16	Professional	TC	$128.76	$320.45	$364.16
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $379.28 / $379.28 / $835.67	Facility	26	$379.28	$379.28	$835.67
Medica Facility/Professional Professional Modifier Low / Median / High Price $161.35 / $420.82 / $1,413.47	Professional		$161.35	$420.82	$1,413.47
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $50.66 / $143.97 / $439.11	Professional	26	$50.66	$143.97	$439.11
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $110.69 / $299.17 / $1,220.00	Professional	TC	$110.69	$299.17	$1,220.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $56.22 / $105.44 / $253.92	Professional		$56.22	$105.44	$253.92
Quartz Facility/Professional Professional Modifier Low / Median / High Price $253.50 / $379.78 / $725.40	Professional		$253.50	$379.78	$725.40
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $379.28 / $379.28	Facility	26	$100.00	$379.28	$379.28
Quartz Facility/Professional Professional Modifier Low / Median / High Price $199.24 / $798.47 / $1,413.47	Professional		$199.24	$798.47	$1,413.47
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $59.85 / $211.10 / $333.52	Professional	26	$59.85	$211.10	$333.52
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $136.68 / $611.72 / $1,220.00	Professional	TC	$136.68	$611.72	$1,220.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $450.46 / $1,531.89 / $1,531.89	Professional		$450.46	$1,531.89	$1,531.89
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $141.05 / $436.73 / $436.73	Professional	26	$141.05	$436.73	$436.73
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $309.41 / $1,095.17 / $1,095.17	Professional	TC	$309.41	$1,095.17	$1,095.17
United Facility/Professional Professional Modifier Low / Median / High Price $146.97 / $336.15 / $669.27	Professional		$146.97	$336.15	$669.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.75 / $104.12 / $185.03	Professional	26	$46.75	$104.12	$185.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.44 / $224.28 / $494.37	Professional	TC	$97.44	$224.28	$494.37