Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.67 / $106.97 / $114.51	Facility	26	$54.67	$106.97	$114.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $136.96 / $271.92 / $1,538.50	Professional		$136.96	$271.92	$1,538.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.45 / $98.98 / $529.54	Professional	26	$47.45	$98.98	$529.54
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $66.72 / $86.15 / $146.99	Professional	52	$66.72	$86.15	$146.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.49 / $166.97 / $586.08	Professional	TC	$83.49	$166.97	$586.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $133.28 / $328.98 / $1,040.38	Professional		$133.28	$328.98	$1,040.38
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.79 / $114.79 / $390.51	Professional	26	$49.79	$114.79	$390.51
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $83.49 / $212.89 / $649.88	Professional	TC	$83.49	$212.89	$649.88
CareSource Facility/Professional Professional Modifier Low / Median / High Price $56.82 / $100.70 / $183.99	Professional		$56.82	$100.70	$183.99
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $134.27 / $156.90 / $208.54	Facility	26	$134.27	$156.90	$208.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.77 / $479.82 / $545.25	Professional		$194.77	$479.82	$545.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.84 / $179.30 / $203.75	Professional	26	$62.84	$179.30	$203.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $121.08 / $300.52 / $341.50	Professional	TC	$121.08	$300.52	$341.50
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $381.90 / $479.84 / $479.84	Facility	26	$381.90	$479.84	$479.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $183.83 / $491.89 / $1,609.32	Professional		$183.83	$491.89	$1,609.32
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $65.42 / $157.72 / $401.25	Professional	26	$65.42	$157.72	$401.25
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $115.22 / $312.07 / $1,384.00	Professional	TC	$115.22	$312.07	$1,384.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $56.22 / $105.44 / $253.57	Professional		$56.22	$105.44	$253.57
Quartz Facility/Professional Professional Modifier Low / Median / High Price $263.25 / $394.39 / $960.34	Professional		$263.25	$394.39	$960.34
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $121.80 / $479.84 / $479.84	Facility	26	$121.80	$479.84	$479.84
Quartz Facility/Professional Professional Modifier Low / Median / High Price $202.09 / $888.45 / $1,609.32	Professional		$202.09	$888.45	$1,609.32
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $75.51 / $285.85 / $394.61	Professional	26	$75.51	$285.85	$394.61
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $128.58 / $708.03 / $1,384.00	Professional	TC	$128.58	$708.03	$1,384.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $584.60 / $854.97 / $854.97	Professional		$584.60	$854.97	$854.97
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $168.80 / $207.61 / $274.45	Professional	26	$168.80	$207.61	$274.45
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $302.14 / $448.86 / $904.67	Professional	TC	$302.14	$448.86	$904.67
United Facility/Professional Professional Modifier Low / Median / High Price $163.38 / $389.33 / $859.87	Professional		$163.38	$389.33	$859.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.72 / $133.18 / $250.55	Professional	26	$60.72	$133.18	$250.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $102.66 / $249.42 / $575.09	Professional	TC	$102.66	$249.42	$575.09