Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $911.00 / $1,713.00 / $4,473.00	Facility		$911.00	$1,713.00	$4,473.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.53 / $127.53 / $157.46	Facility	26	$127.53	$127.53	$157.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $336.76 / $400.77 / $628.27	Professional		$336.76	$400.77	$628.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $122.12 / $132.90 / $518.66	Professional	26	$122.12	$132.90	$518.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $205.37 / $273.25 / $441.85	Professional	TC	$205.37	$273.25	$441.85
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $324.81 / $448.53 / $678.71	Professional		$324.81	$448.53	$678.71
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $127.20 / $147.38 / $212.13	Professional	26	$127.20	$147.38	$212.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $196.97 / $308.33 / $466.57	Professional	TC	$196.97	$308.33	$466.57
Cigna Facility/Professional Facility Modifier Low / Median / High Price $238.24 / $238.24 / $238.24	Facility		$238.24	$238.24	$238.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $287.62 / $355.45 / $613.42	Professional		$287.62	$355.45	$613.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.92 / $135.43 / $195.19	Professional	26	$104.92	$135.43	$195.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $182.70 / $222.75 / $418.23	Professional	TC	$182.70	$222.75	$418.23
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $9.36 / $382.25 / $617.02	Professional		$9.36	$382.25	$617.02
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $2.31 / $143.05 / $217.68	Professional	26	$2.31	$143.05	$217.68
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $7.76 / $262.42 / $410.74	Professional	TC	$7.76	$262.42	$410.74
Hometown Health Facility/Professional Facility Modifier Low / Median / High Price $737.67 / $737.67 / $737.67	Facility		$737.67	$737.67	$737.67
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $7.02 / $346.48 / $528.87	Professional		$7.02	$346.48	$528.87
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1.74 / $124.39 / $186.59	Professional	26	$1.74	$124.39	$186.59
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $5.28 / $228.19 / $357.53	Professional	TC	$5.28	$228.19	$357.53
United Facility/Professional Facility Modifier Low / Median / High Price $408.00 / $1,925.00 / $4,715.00	Facility		$408.00	$1,925.00	$4,715.00
United Facility/Professional Professional Modifier Low / Median / High Price $348.12 / $426.80 / $672.22	Professional		$348.12	$426.80	$672.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $129.32 / $171.63 / $230.59	Professional	26	$129.32	$171.63	$230.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $226.61 / $273.39 / $441.63	Professional	TC	$226.61	$273.39	$441.63