Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $161.30 / $173.16 / $185.49	Facility	26	$161.30	$173.16	$185.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $254.32 / $502.53 / $2,781.00	Professional		$254.32	$502.53	$2,781.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.30 / $161.30 / $714.00	Professional	26	$79.30	$161.30	$714.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $170.48 / $341.24 / $882.03	Professional	TC	$170.48	$341.24	$882.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $276.48 / $642.85 / $2,159.46	Professional		$276.48	$642.85	$2,159.46
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $80.65 / $191.76 / $630.47	Professional	26	$80.65	$191.76	$630.47
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $195.84 / $457.51 / $1,510.93	Professional	TC	$195.84	$457.51	$1,510.93
CareSource Facility/Professional Professional Modifier Low / Median / High Price $91.98 / $237.26 / $380.96	Professional		$91.98	$237.26	$380.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $217.17 / $253.78 / $337.29	Facility	26	$217.17	$253.78	$337.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $390.00 / $995.34 / $1,131.06	Professional		$390.00	$995.34	$1,131.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $95.17 / $289.55 / $329.04	Professional	26	$95.17	$289.55	$329.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $274.06 / $705.82 / $802.06	Professional	TC	$274.06	$705.82	$802.06
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $616.54 / $773.84 / $1,740.00	Facility	26	$616.54	$773.84	$1,740.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $344.05 / $855.87 / $3,234.12	Professional		$344.05	$855.87	$3,234.12
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $101.66 / $247.13 / $602.74	Professional	26	$101.66	$247.13	$602.74
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $240.71 / $638.02 / $2,749.60	Professional	TC	$240.71	$638.02	$2,749.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $80.83 / $188.32 / $487.55	Professional		$80.83	$188.32	$487.55
Quartz Facility/Professional Professional Modifier Low / Median / High Price $547.29 / $723.79 / $1,203.55	Professional		$547.29	$723.79	$1,203.55
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $196.70 / $773.84 / $773.84	Facility	26	$196.70	$773.84	$773.84
Quartz Facility/Professional Professional Modifier Low / Median / High Price $419.22 / $1,544.28 / $3,234.12	Professional		$419.22	$1,544.28	$3,234.12
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $121.95 / $430.60 / $559.72	Professional	26	$121.95	$430.60	$559.72
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $297.27 / $1,271.96 / $2,749.60	Professional	TC	$297.27	$1,271.96	$2,749.60
Security Health Facility/Professional Professional Modifier Low / Median / High Price $949.23 / $1,629.47 / $1,629.47	Professional		$949.23	$1,629.47	$1,629.47
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $273.11 / $289.23 / $471.50	Professional	26	$273.11	$289.23	$471.50
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $660.00 / $758.63 / $2,339.92	Professional	TC	$660.00	$758.63	$2,339.92
United Facility/Professional Professional Modifier Low / Median / High Price $332.74 / $716.78 / $1,427.07	Professional		$332.74	$716.78	$1,427.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $94.84 / $179.00 / $377.42	Professional	26	$94.84	$179.00	$377.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $220.57 / $529.88 / $1,159.20	Professional	TC	$220.57	$529.88	$1,159.20