Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $205.23 / $205.23 / $394.42	Facility	26	$205.23	$205.23	$394.42
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $91.61 / $91.61 / $173.98	Facility	53	$91.61	$91.61	$173.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $243.49 / $401.31 / $869.89	Professional		$243.49	$401.31	$869.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $99.15 / $205.23 / $978.00	Professional	26	$99.15	$205.23	$978.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $241.54 / $458.05 / $1,683.45	Professional		$241.54	$458.05	$1,683.45
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $108.22 / $205.23 / $726.76	Professional	26	$108.22	$205.23	$726.76
CareSource Facility/Professional Professional Modifier Low / Median / High Price $107.65 / $146.79 / $286.75	Professional		$107.65	$146.79	$286.75
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $276.64 / $323.27 / $495.92	Facility	26	$276.64	$323.27	$495.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $348.39 / $681.80 / $774.78	Professional		$348.39	$681.80	$774.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $140.96 / $303.93 / $345.38	Professional	26	$140.96	$303.93	$345.38
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $985.36 / $985.36 / $985.36	Facility	26	$985.36	$985.36	$985.36
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $228.96 / $228.96 / $228.96	Facility	53	$228.96	$228.96	$228.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $280.36 / $542.14 / $1,920.39	Professional		$280.36	$542.14	$1,920.39
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $119.96 / $232.49 / $1,030.27	Professional	26	$119.96	$232.49	$1,030.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $80.47 / $197.87 / $437.49	Professional		$80.47	$197.87	$437.49
Quartz Facility/Professional Professional Modifier Low / Median / High Price $435.00 / $663.54 / $900.74	Professional		$435.00	$663.54	$900.74
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $251.75 / $985.36 / $985.36	Facility	26	$251.75	$985.36	$985.36
Quartz Facility/Professional Facility Modifier 53 Low / Median / High Price $112.95 / $228.96 / $228.96	Facility	53	$112.95	$228.96	$228.96
Quartz Facility/Professional Professional Modifier Low / Median / High Price $365.96 / $1,212.19 / $1,920.39	Professional		$365.96	$1,212.19	$1,920.39
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $163.13 / $545.25 / $1,030.27	Professional	26	$163.13	$545.25	$1,030.27
Security Health Facility/Professional Professional Modifier Low / Median / High Price $698.85 / $1,615.45 / $1,615.45	Professional		$698.85	$1,615.45	$1,615.45
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $305.13 / $452.66 / $553.92	Professional	26	$305.13	$452.66	$553.92
United Facility/Professional Professional Modifier Low / Median / High Price $267.70 / $480.24 / $1,087.52	Professional		$267.70	$480.24	$1,087.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $90.00 / $170.74 / $477.92	Professional	26	$90.00	$170.74	$477.92