Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $147.91 / $190.55 / $281.84	Facility	26	$147.91	$190.55	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $467.74 / $2,137.96	Professional		$204.17	$467.74	$2,137.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $100.00 / $407.38	Professional	26	$66.07	$100.00	$407.38
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $75.86 / $169.82 / $524.81	Professional	52	$75.86	$169.82	$524.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $251.19 / $660.69	Professional	TC	$131.83	$251.19	$660.69
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $380.19 / $1,148.15	Professional		$194.98	$380.19	$1,148.15
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $109.65 / $398.11	Professional	26	$67.61	$109.65	$398.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $263.03 / $812.83	Professional	TC	$128.82	$263.03	$812.83
CareSource Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $154.88 / $257.04	Professional		$89.13	$154.88	$257.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $181.97 / $213.80 / $338.84	Facility	26	$181.97	$213.80	$338.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $588.84 / $831.76	Professional		$229.09	$588.84	$831.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $158.49 / $281.84	Professional	26	$64.57	$158.49	$281.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $407.38 / $537.03	Professional	TC	$154.88	$407.38	$537.03
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $436.52 / $602.56	Professional		$371.54	$436.52	$602.56
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $154.88 / $208.93	Professional	26	$128.82	$154.88	$208.93
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $288.40 / $398.11	Professional	TC	$239.88	$288.40	$398.11
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $660.69 / $660.69 / $1,737.80	Facility	26	$660.69	$660.69	$1,737.80
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $288.40 / $288.40 / $288.40	Facility	53	$288.40	$288.40	$288.40
Medica Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $676.08 / $2,884.03	Professional		$257.04	$676.08	$2,884.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $199.53 / $933.25	Professional	26	$79.43	$199.53	$933.25
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $467.74 / $2,511.89	Professional	TC	$169.82	$467.74	$2,511.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $549.54	Professional		$32.36	$33.11	$549.54
Quartz Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $501.19 / $2,041.74	Professional		$257.04	$501.19	$2,041.74
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $645.65 / $645.65	Facility	26	$162.18	$645.65	$645.65
Quartz Facility/Professional Facility Modifier 53 Low / Median / High Price $95.50 / $524.81 / $524.81	Facility	53	$95.50	$524.81	$524.81
Quartz Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $1,659.59 / $2,951.21	Professional		$316.23	$1,659.59	$2,951.21
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $363.08 / $588.84	Professional	26	$87.10	$363.08	$588.84
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $1,412.54 / $2,570.40	Professional	TC	$199.53	$1,412.54	$2,570.40
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $1,737.80 / $2,754.23	Professional		$1,288.25	$1,737.80	$2,754.23
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $302.00 / $446.68 / $912.01	Professional	26	$302.00	$446.68	$912.01
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $851.14 / $1,380.38 / $1,862.09	Professional	TC	$851.14	$1,380.38	$1,862.09
United Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $467.74 / $954.99	Professional		$229.09	$467.74	$954.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $123.03 / $269.15	Professional	26	$75.86	$123.03	$269.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $323.59 / $812.83	Professional	TC	$151.36	$323.59	$812.83