Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $256.19 / $285.35 / $328.15	Facility	26	$256.19	$285.35	$328.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $388.90 / $610.94 / $2,686.27	Professional		$388.90	$610.94	$2,686.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $124.72 / $279.49 / $1,177.05	Professional	26	$124.72	$279.49	$1,177.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $260.14 / $368.50 / $787.51	Professional	TC	$260.14	$368.50	$787.51
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $367.96 / $918.97 / $2,935.42	Professional		$367.96	$918.97	$2,935.42
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $118.89 / $282.70 / $933.75	Professional	26	$118.89	$282.70	$933.75
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $249.06 / $626.87 / $2,001.67	Professional	TC	$249.06	$626.87	$2,001.67
CareSource Facility/Professional Professional Modifier Low / Median / High Price $136.10 / $291.76 / $497.40	Professional		$136.10	$291.76	$497.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $319.89 / $373.83 / $496.85	Facility	26	$319.89	$373.83	$496.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $521.01 / $1,317.16 / $1,496.78	Professional		$521.01	$1,317.16	$1,496.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $135.65 / $428.48 / $486.91	Professional	26	$135.65	$428.48	$486.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $350.76 / $888.69 / $1,009.88	Professional	TC	$350.76	$888.69	$1,009.88
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $1,142.00 / $1,142.00 / $1,142.00	Facility	26	$1,142.00	$1,142.00	$1,142.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $512.97 / $1,180.65 / $3,919.13	Professional		$512.97	$1,180.65	$3,919.13
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $151.66 / $342.52 / $771.93	Professional	26	$151.66	$342.52	$771.93
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $355.31 / $847.86 / $3,292.02	Professional	TC	$355.31	$847.86	$3,292.02
Molina Facility/Professional Professional Modifier Low / Median / High Price $107.97 / $253.01 / $666.59	Professional		$107.97	$253.01	$666.59
Quartz Facility/Professional Professional Modifier Low / Median / High Price $713.05 / $1,068.26 / $1,592.70	Professional		$713.05	$1,068.26	$1,592.70
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $291.08 / $1,142.00 / $1,142.00	Facility	26	$291.08	$1,142.00	$1,142.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $554.76 / $2,035.60 / $3,919.13	Professional		$554.76	$2,035.60	$3,919.13
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $180.47 / $631.95 / $771.93	Professional	26	$180.47	$631.95	$771.93
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $374.30 / $1,496.13 / $3,292.02	Professional	TC	$374.30	$1,496.13	$3,292.02
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,134.44 / $2,347.04 / $2,713.94	Professional		$2,134.44	$2,347.04	$2,713.94
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $618.17 / $697.15 / $919.09	Professional	26	$618.17	$697.15	$919.09
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,375.00 / $1,738.37 / $2,067.62	Professional	TC	$1,375.00	$1,738.37	$2,067.62
United Facility/Professional Professional Modifier Low / Median / High Price $447.78 / $1,059.03 / $1,891.26	Professional		$447.78	$1,059.03	$1,891.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $144.19 / $328.78 / $553.90	Professional	26	$144.19	$328.78	$553.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $336.87 / $814.12 / $2,253.17	Professional	TC	$336.87	$814.12	$2,253.17