Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $121.19 / $121.19 / $417.24	Facility	26	$121.19	$121.19	$417.24
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $161.49 / $161.49 / $519.98	Facility	53	$161.49	$161.49	$519.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $766.68 / $1,261.33 / $4,572.00	Professional		$766.68	$1,261.33	$4,572.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $113.20 / $187.33 / $1,043.00	Professional	26	$113.20	$187.33	$1,043.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $369.75 / $403.73 / $1,334.97	Professional	52	$369.75	$403.73	$1,334.97
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $147.90 / $167.17 / $607.64	Professional	53	$147.90	$167.17	$607.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $653.48 / $802.61 / $2,132.98	Professional	TC	$653.48	$802.61	$2,132.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $787.50 / $1,441.87 / $3,262.16	Professional		$787.50	$1,441.87	$3,262.16
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $127.08 / $216.40 / $540.23	Professional	26	$127.08	$216.40	$540.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $645.82 / $1,225.47 / $2,776.82	Professional	TC	$645.82	$1,225.47	$2,776.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $294.67 / $344.34 / $457.66	Facility	26	$294.67	$344.34	$457.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $905.57 / $1,859.24 / $2,112.78	Professional		$905.57	$1,859.24	$2,112.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $143.59 / $284.19 / $323.22	Professional	26	$143.59	$284.19	$323.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $730.06 / $1,575.06 / $1,789.84	Professional	TC	$730.06	$1,575.06	$1,789.84
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $789.30 / $789.30 / $789.30	Facility	26	$789.30	$789.30	$789.30
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $643.30 / $643.30 / $643.30	Facility	53	$643.30	$643.30	$643.30
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,093.88 / $2,013.83 / $5,332.25	Professional		$1,093.88	$2,013.83	$5,332.25
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $185.20 / $326.50 / $1,044.83	Professional	26	$185.20	$326.50	$1,044.83
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $900.52 / $1,772.68 / $4,416.72	Professional	TC	$900.52	$1,772.68	$4,416.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $80.97 / $506.28 / $1,311.61	Professional		$80.97	$506.28	$1,311.61
Quartz Facility/Professional Professional Modifier Low / Median / High Price $1,357.85 / $1,805.09 / $2,543.78	Professional		$1,357.85	$1,805.09	$2,543.78
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $267.18 / $789.30 / $789.30	Facility	26	$267.18	$789.30	$789.30
Quartz Facility/Professional Facility Modifier 53 Low / Median / High Price $349.60 / $643.30 / $643.30	Facility	53	$349.60	$643.30	$643.30
Quartz Facility/Professional Professional Modifier Low / Median / High Price $964.88 / $4,184.85 / $5,332.25	Professional		$964.88	$4,184.85	$5,332.25
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $153.90 / $770.15 / $1,044.83	Professional	26	$153.90	$770.15	$1,044.83
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $817.40 / $3,545.35 / $4,416.72	Professional	TC	$817.40	$3,545.35	$4,416.72
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,313.17 / $3,348.04 / $3,755.28	Professional		$1,313.17	$3,348.04	$3,755.28
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $263.25 / $440.88 / $585.91	Professional	26	$263.25	$440.88	$585.91
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $984.30 / $1,891.33 / $2,393.10	Professional	TC	$984.30	$1,891.33	$2,393.10
United Facility/Professional Professional Modifier Low / Median / High Price $1,004.36 / $1,822.61 / $3,231.46	Professional		$1,004.36	$1,822.61	$3,231.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $153.47 / $290.33 / $493.81	Professional	26	$153.47	$290.33	$493.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $850.88 / $1,467.77 / $2,737.65	Professional	TC	$850.88	$1,467.77	$2,737.65