Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.92 / $58.92 / $201.06	Facility	26	$58.92	$58.92	$201.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.64 / $368.17 / $1,331.00	Professional		$257.64	$368.17	$1,331.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.89 / $129.22 / $594.97	Professional	26	$58.89	$129.22	$594.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.77 / $227.63 / $481.55	Professional	TC	$169.77	$227.63	$481.55
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $269.66 / $493.90 / $1,585.04	Professional		$269.66	$493.90	$1,585.04
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.16 / $103.07 / $340.04	Professional	26	$56.16	$103.07	$340.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $214.21 / $372.89 / $1,287.33	Professional	TC	$214.21	$372.89	$1,287.33
CareSource Facility/Professional Professional Modifier Low / Median / High Price $55.12 / $220.85 / $315.85	Professional		$55.12	$220.85	$315.85
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.47 / $165.33 / $253.61	Facility	26	$141.47	$165.33	$253.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $323.45 / $668.97 / $760.19	Professional		$323.45	$668.97	$760.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.19 / $136.65 / $155.29	Professional	26	$66.19	$136.65	$155.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $240.21 / $532.30 / $604.90	Professional	TC	$240.21	$532.30	$604.90
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $377.88 / $377.88 / $377.88	Facility	26	$377.88	$377.88	$377.88
Medica Facility/Professional Professional Modifier Low / Median / High Price $347.87 / $593.54 / $2,362.07	Professional		$347.87	$593.54	$2,362.07
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $73.54 / $142.75 / $507.12	Professional	26	$73.54	$142.75	$507.12
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $273.08 / $467.06 / $1,854.93	Professional	TC	$273.08	$467.06	$1,854.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $58.14 / $254.81 / $506.65	Professional		$58.14	$254.81	$506.65
Quartz Facility/Professional Professional Modifier Low / Median / High Price $198.32 / $616.04 / $886.90	Professional		$198.32	$616.04	$886.90
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $128.47 / $377.88 / $377.88	Facility	26	$128.47	$377.88	$377.88
Quartz Facility/Professional Professional Modifier Low / Median / High Price $301.88 / $1,337.95 / $2,362.07	Professional		$301.88	$1,337.95	$2,362.07
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $61.67 / $358.61 / $507.12	Professional	26	$61.67	$358.61	$507.12
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $240.21 / $1,058.34 / $1,854.93	Professional	TC	$240.21	$1,058.34	$1,854.93
Security Health Facility/Professional Professional Modifier Low / Median / High Price $511.84 / $1,351.13 / $1,351.13	Professional		$511.84	$1,351.13	$1,351.13
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $143.35 / $181.38 / $261.89	Professional	26	$143.35	$181.38	$261.89
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $305.13 / $548.66 / $838.60	Professional	TC	$305.13	$548.66	$838.60
United Facility/Professional Professional Modifier Low / Median / High Price $308.83 / $536.71 / $1,033.14	Professional		$308.83	$536.71	$1,033.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.94 / $129.11 / $254.95	Professional	26	$67.94	$129.11	$254.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $263.11 / $440.44 / $932.07	Professional	TC	$263.11	$440.44	$932.07