Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $630.96 / $630.96 / $891.25	Facility	26	$630.96	$630.96	$891.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,548.82 / $2,454.71 / $8,709.64	Professional		$1,548.82	$2,454.71	$8,709.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $371.54 / $630.96 / $1,862.09	Professional	26	$371.54	$630.96	$1,862.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,174.90 / $1,737.80 / $3,630.78	Professional	TC	$1,174.90	$1,737.80	$3,630.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,778.28 / $2,754.23 / $10,000.00	Professional		$1,778.28	$2,754.23	$10,000.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $407.38 / $630.96 / $2,290.87	Professional	26	$407.38	$630.96	$2,290.87
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,348.96 / $2,089.30 / $7,762.47	Professional	TC	$1,348.96	$2,089.30	$7,762.47
CareSource Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $1,698.24 / $2,290.87	Professional		$549.54	$1,698.24	$2,290.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $1,122.02 / $1,288.25 / $2,089.30	Facility	26	$1,122.02	$1,288.25	$2,089.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,511.89 / $5,495.41 / $9,549.93	Professional		$2,511.89	$5,495.41	$9,549.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $575.44 / $1,348.96 / $2,187.76	Professional	26	$575.44	$1,348.96	$2,187.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $2,041.74 / $4,168.69 / $7,413.10	Professional	TC	$2,041.74	$4,168.69	$7,413.10
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $3,715.35 / $4,265.80 / $5,128.61	Professional		$3,715.35	$4,265.80	$5,128.61
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $851.14 / $1,000.00 / $1,202.26	Professional	26	$851.14	$1,000.00	$1,202.26
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $2,818.38 / $3,311.31 / $3,981.07	Professional	TC	$2,818.38	$3,311.31	$3,981.07
Medica Facility/Professional Professional Modifier Low / Median / High Price $2,238.72 / $4,265.80 / $13,489.63	Professional		$2,238.72	$4,265.80	$13,489.63
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $457.09 / $954.99 / $2,818.38	Professional	26	$457.09	$954.99	$2,818.38
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $1,737.80 / $3,090.30 / $8,912.51	Professional	TC	$1,737.80	$3,090.30	$8,912.51
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $2,630.27	Professional		$32.36	$33.11	$2,630.27
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,511.89 / $4,677.35 / $8,128.31	Professional		$2,511.89	$4,677.35	$8,128.31
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $1,000.00 / $2,630.27 / $2,630.27	Facility	26	$1,000.00	$2,630.27	$2,630.27
Quartz Facility/Professional Professional Modifier Low / Median / High Price $2,691.53 / $9,332.54 / $14,125.38	Professional		$2,691.53	$9,332.54	$14,125.38
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $616.60 / $2,089.30 / $2,951.21	Professional	26	$616.60	$2,089.30	$2,951.21
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $2,041.74 / $7,244.36 / $8,912.51	Professional	TC	$2,041.74	$7,244.36	$8,912.51
Security Health Facility/Professional Professional Modifier Low / Median / High Price $6,456.54 / $11,220.18 / $14,125.38	Professional		$6,456.54	$11,220.18	$14,125.38
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,202.26 / $1,412.54 / $2,398.83	Professional	26	$1,202.26	$1,412.54	$2,398.83
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $4,570.88 / $5,128.61 / $8,709.64	Professional	TC	$4,570.88	$5,128.61	$8,709.64
United Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $3,467.37 / $8,128.31	Professional		$1,949.84	$3,467.37	$8,128.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $436.52 / $758.58 / $1,862.09	Professional	26	$436.52	$758.58	$1,862.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,513.56 / $2,754.23 / $6,309.57	Professional	TC	$1,513.56	$2,754.23	$6,309.57