Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.18 / $117.18 / $125.91	Facility	26	$117.18	$117.18	$125.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.22 / $458.85 / $2,138.90	Professional		$250.22	$458.85	$2,138.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.24 / $117.18 / $570.72	Professional	26	$58.24	$117.18	$570.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $168.65 / $305.50 / $472.29	Professional	TC	$168.65	$305.50	$472.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $235.86 / $550.01 / $1,801.09	Professional		$235.86	$550.01	$1,801.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.59 / $139.31 / $460.45	Professional	26	$58.59	$139.31	$460.45
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $170.39 / $415.13 / $1,326.89	Professional	TC	$170.39	$415.13	$1,326.89
CareSource Facility/Professional Professional Modifier Low / Median / High Price $66.89 / $202.40 / $317.14	Professional		$66.89	$202.40	$317.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $157.69 / $184.28 / $244.92	Facility	26	$157.69	$184.28	$244.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $323.05 / $841.54 / $956.30	Professional		$323.05	$841.54	$956.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.27 / $211.17 / $239.96	Professional	26	$69.27	$211.17	$239.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $238.00 / $630.38 / $716.34	Professional	TC	$238.00	$630.38	$716.34
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $565.04 / $565.04 / $565.04	Facility	26	$565.04	$565.04	$565.04
Medica Facility/Professional Professional Modifier Low / Median / High Price $286.95 / $648.04 / $1,846.75	Professional		$286.95	$648.04	$1,846.75
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $71.83 / $166.34 / $444.14	Professional	26	$71.83	$166.34	$444.14
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $211.39 / $486.03 / $2,104.00	Professional	TC	$211.39	$486.03	$2,104.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $58.40 / $183.38 / $436.16	Professional		$58.40	$183.38	$436.16
Quartz Facility/Professional Professional Modifier Low / Median / High Price $456.30 / $668.30 / $1,104.10	Professional		$456.30	$668.30	$1,104.10
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $143.44 / $565.04 / $565.04	Facility	26	$143.44	$565.04	$565.04
Quartz Facility/Professional Professional Modifier Low / Median / High Price $354.44 / $1,178.50 / $1,846.75	Professional		$354.44	$1,178.50	$1,846.75
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $88.94 / $314.85 / $444.14	Professional	26	$88.94	$314.85	$444.14
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $265.50 / $863.65 / $2,104.00	Professional	TC	$265.50	$863.65	$2,104.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $747.76 / $1,491.14 / $1,491.14	Professional		$747.76	$1,491.14	$1,491.14
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $210.70 / $224.55 / $344.31	Professional	26	$210.70	$224.55	$344.31
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $537.04 / $660.52 / $1,220.27	Professional	TC	$537.04	$660.52	$1,220.27
United Facility/Professional Professional Modifier Low / Median / High Price $277.04 / $597.83 / $1,268.19	Professional		$277.04	$597.83	$1,268.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.56 / $115.80 / $382.31	Professional	26	$75.56	$115.80	$382.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $202.09 / $440.03 / $772.02	Professional	TC	$202.09	$440.03	$772.02