Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $134.53 / $150.99 / $197.00	Facility	26	$134.53	$150.99	$197.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.69 / $494.18 / $2,183.40	Professional		$208.69	$494.18	$2,183.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.06 / $175.52 / $756.50	Professional	26	$66.06	$175.52	$756.50
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,218.00 / $1,218.00 / $1,218.00	Professional	50	$1,218.00	$1,218.00	$1,218.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $107.68 / $215.98 / $379.30	Professional	52	$107.68	$215.98	$379.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.29 / $338.15 / $816.80	Professional	TC	$154.29	$338.15	$816.80
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $203.81 / $487.24 / $1,598.69	Professional		$203.81	$487.24	$1,598.69
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.91 / $149.59 / $492.66	Professional	26	$62.91	$149.59	$492.66
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $305.70 / $778.53 / $2,398.03	Professional	50	$305.70	$778.53	$2,398.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $140.90 / $342.14 / $1,106.03	Professional	TC	$140.90	$342.14	$1,106.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $71.42 / $170.82 / $280.56	Professional		$71.42	$170.82	$280.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $168.51 / $196.92 / $261.72	Facility	26	$168.51	$196.92	$261.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $297.57 / $734.12 / $834.23	Professional		$297.57	$734.12	$834.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.17 / $225.67 / $256.44	Professional	26	$72.17	$225.67	$256.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $204.90 / $508.45 / $577.79	Professional	TC	$204.90	$508.45	$577.79
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $603.28 / $603.28 / $1,751.50	Facility	26	$603.28	$603.28	$1,751.50
Medica Facility/Professional Professional Modifier Low / Median / High Price $284.58 / $731.00 / $2,789.74	Professional		$284.58	$731.00	$2,789.74
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $80.95 / $195.63 / $542.85	Professional	26	$80.95	$195.63	$542.85
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $200.65 / $526.33 / $2,451.15	Professional	TC	$200.65	$526.33	$2,451.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $54.30 / $126.60 / $368.75	Professional		$54.30	$126.60	$368.75
Quartz Facility/Professional Professional Modifier Low / Median / High Price $403.00 / $603.76 / $2,083.82	Professional		$403.00	$603.76	$2,083.82
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $153.30 / $603.28 / $603.28	Facility	26	$153.30	$603.28	$603.28
Quartz Facility/Professional Professional Modifier Low / Median / High Price $349.08 / $1,528.39 / $2,789.74	Professional		$349.08	$1,528.39	$2,789.74
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $95.04 / $337.30 / $542.85	Professional	26	$95.04	$337.30	$542.85
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $218.67 / $1,318.47 / $2,451.15	Professional	TC	$218.67	$1,318.47	$2,451.15
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,291.00 / $2,821.25 / $2,821.25	Professional		$1,291.00	$2,821.25	$2,821.25
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $306.33 / $840.33 / $840.33	Professional	26	$306.33	$840.33	$840.33
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $911.86 / $1,980.92 / $1,980.92	Professional	TC	$911.86	$1,980.92	$1,980.92
United Facility/Professional Professional Modifier Low / Median / High Price $250.06 / $586.12 / $1,282.58	Professional		$250.06	$586.12	$1,282.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $76.30 / $162.84 / $295.64	Professional	26	$76.30	$162.84	$295.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $185.22 / $416.75 / $1,061.50	Professional	TC	$185.22	$416.75	$1,061.50