Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $146.32 / $164.13 / $188.74	Facility	26	$146.32	$164.13	$188.74
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $83.41 / $83.41 / $94.58	Facility	53	$83.41	$83.41	$94.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $213.91 / $494.18 / $2,346.00	Professional		$213.91	$494.18	$2,346.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.70 / $164.13 / $810.28	Professional	26	$66.70	$164.13	$810.28
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $104.28 / $161.82 / $308.98	Professional	52	$104.28	$161.82	$308.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $137.53 / $308.79 / $724.00	Professional	TC	$137.53	$308.79	$724.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $197.05 / $470.08 / $1,547.88	Professional		$197.05	$470.08	$1,547.88
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $68.39 / $162.61 / $534.92	Professional	26	$68.39	$162.61	$534.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $128.66 / $328.09 / $1,012.95	Professional	TC	$128.66	$328.09	$1,012.95
CareSource Facility/Professional Professional Modifier Low / Median / High Price $77.73 / $155.25 / $271.22	Professional		$77.73	$155.25	$271.22
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $182.93 / $213.77 / $284.11	Facility	26	$182.93	$213.77	$284.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $287.29 / $709.39 / $806.13	Professional		$287.29	$709.39	$806.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.08 / $245.50 / $278.98	Professional	26	$81.08	$245.50	$278.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.50 / $463.88 / $527.14	Professional	TC	$186.50	$463.88	$527.14
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $656.72 / $656.72 / $1,754.00	Facility	26	$656.72	$656.72	$1,754.00
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $285.58 / $285.58 / $285.58	Facility	53	$285.58	$285.58	$285.58
Medica Facility/Professional Professional Modifier Low / Median / High Price $280.22 / $735.03 / $2,872.81	Professional		$280.22	$735.03	$2,872.81
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $87.82 / $218.17 / $605.60	Professional	26	$87.82	$218.17	$605.60
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $185.08 / $487.68 / $2,498.98	Professional	TC	$185.08	$487.68	$2,498.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $54.30 / $126.15 / $308.19	Professional		$54.30	$126.15	$308.19
Quartz Facility/Professional Professional Modifier Low / Median / High Price $388.70 / $582.33 / $2,046.99	Professional		$388.70	$582.33	$2,046.99
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $166.78 / $656.72 / $656.72	Facility	26	$166.78	$656.72	$656.72
Quartz Facility/Professional Facility Modifier 53 Low / Median / High Price $96.55 / $285.58 / $285.58	Facility	53	$96.55	$285.58	$285.58
Quartz Facility/Professional Professional Modifier Low / Median / High Price $337.34 / $1,572.65 / $2,872.81	Professional		$337.34	$1,572.65	$2,872.81
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $103.40 / $365.90 / $584.49	Professional	26	$103.40	$365.90	$584.49
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $198.44 / $1,341.18 / $2,498.98	Professional	TC	$198.44	$1,341.18	$2,498.98
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,258.48 / $2,755.77 / $2,755.77	Professional		$1,258.48	$2,755.77	$2,755.77
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $321.30 / $911.00 / $911.00	Professional	26	$321.30	$911.00	$911.00
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $847.49 / $1,844.77 / $1,844.77	Professional	TC	$847.49	$1,844.77	$1,844.77
United Facility/Professional Professional Modifier Low / Median / High Price $258.66 / $569.39 / $1,332.09	Professional		$258.66	$569.39	$1,332.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $82.96 / $185.21 / $357.13	Professional	26	$82.96	$185.21	$357.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $170.84 / $384.40 / $1,146.88	Professional	TC	$170.84	$384.40	$1,146.88