Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $124.86 / $1,706.00 / $4,473.00	Facility		$124.86	$1,706.00	$4,473.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $84.27 / $85.22 / $93.65	Facility	54	$84.27	$85.22	$93.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.07 / $114.19 / $558.00	Professional		$102.07	$114.19	$558.00
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $84.27 / $89.78 / $479.69	Professional	54	$84.27	$89.78	$479.69
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,529.00 / $3,433.00 / $4,098.00	Facility		$1,529.00	$3,433.00	$4,098.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.00 / $124.32 / $199.38	Professional		$112.00	$124.32	$199.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $84.40 / $84.40 / $84.40	Facility		$84.40	$84.40	$84.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $101.38 / $144.44 / $209.91	Professional		$101.38	$144.44	$209.91
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $0.71 / $136.41 / $213.62	Professional		$0.71	$136.41	$213.62
Hometown Health Facility/Professional Facility Modifier Low / Median / High Price $265.11 / $265.11 / $265.11	Facility		$265.11	$265.11	$265.11
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $0.48 / $138.27 / $195.27	Professional		$0.48	$138.27	$195.27
United Facility/Professional Facility Modifier Low / Median / High Price $200.00 / $1,427.00 / $1,998.00	Facility		$200.00	$1,427.00	$1,998.00
United Facility/Professional Professional Modifier Low / Median / High Price $104.10 / $135.00 / $218.61	Professional		$104.10	$135.00	$218.61