Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $216.20 / $216.20 / $438.17	Facility	26	$216.20	$216.20	$438.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $640.02 / $832.55 / $2,281.50	Professional		$640.02	$832.55	$2,281.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $115.95 / $191.28 / $1,113.50	Professional	26	$115.95	$191.28	$1,113.50
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $237.93 / $343.82 / $554.20	Professional	52	$237.93	$343.82	$554.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $492.83 / $629.47 / $1,183.46	Professional	TC	$492.83	$629.47	$1,183.46
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $586.26 / $863.38 / $2,456.53	Professional		$586.26	$863.38	$2,456.53
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $119.97 / $168.41 / $487.87	Professional	26	$119.97	$168.41	$487.87
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $469.57 / $694.97 / $1,979.93	Professional	TC	$469.57	$694.97	$1,979.93
CareSource Facility/Professional Professional Modifier Low / Median / High Price $130.38 / $546.28 / $761.36	Professional		$130.38	$546.28	$761.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $309.08 / $361.19 / $554.07	Facility	26	$309.08	$361.19	$554.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $780.07 / $1,636.96 / $2,935.49	Professional		$780.07	$1,636.96	$2,935.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $149.72 / $294.89 / $553.83	Professional	26	$149.72	$294.89	$553.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $629.14 / $1,342.07 / $2,381.66	Professional	TC	$629.14	$1,342.07	$2,381.66
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $1,685.00 / $1,685.00 / $1,685.00	Facility	26	$1,685.00	$1,685.00	$1,685.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $785.03 / $1,504.87 / $6,200.00	Professional		$785.03	$1,504.87	$6,200.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $168.14 / $328.38 / $2,600.00	Professional	26	$168.14	$328.38	$2,600.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $620.74 / $1,196.70 / $7,000.00	Professional	TC	$620.74	$1,196.70	$7,000.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $107.97 / $421.90 / $1,172.23	Professional		$107.97	$421.90	$1,172.23
Quartz Facility/Professional Professional Modifier Low / Median / High Price $680.84 / $1,435.77 / $2,069.10	Professional		$680.84	$1,435.77	$2,069.10
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $701.13 / $701.13 / $701.13	Facility	26	$701.13	$701.13	$701.13
Quartz Facility/Professional Professional Modifier Low / Median / High Price $943.29 / $2,947.50 / $6,200.00	Professional		$943.29	$2,947.50	$6,200.00
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $196.43 / $665.85 / $2,600.00	Professional	26	$196.43	$665.85	$2,600.00
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $769.14 / $2,343.90 / $7,000.00	Professional	TC	$769.14	$2,343.90	$7,000.00
Security Health Facility/Professional Professional Modifier Low / Median / High Price $1,013.83 / $3,195.25 / $3,195.25	Professional		$1,013.83	$3,195.25	$3,195.25
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $148.47 / $305.61 / $695.42	Professional	26	$148.47	$305.61	$695.42
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $599.12 / $1,222.67 / $2,993.01	Professional	TC	$599.12	$1,222.67	$2,993.01
United Facility/Professional Professional Modifier Low / Median / High Price $736.92 / $1,258.33 / $2,259.85	Professional		$736.92	$1,258.33	$2,259.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $308.17 / $551.00	Professional	26	$100.00	$308.17	$551.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $602.36 / $1,039.27 / $1,809.91	Professional	TC	$602.36	$1,039.27	$1,809.91