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 $40.43 / $40.43 / $49.92	Facility	26	$40.43	$40.43	$49.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.13 / $213.35 / $672.00	Professional		$140.13	$213.35	$672.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.25 / $43.81 / $182.80	Professional	26	$40.25	$43.81	$182.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.17 / $161.43 / $240.16	Professional	TC	$94.17	$161.43	$240.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $142.44 / $226.75 / $343.12	Professional		$142.44	$226.75	$343.12
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.32 / $46.71 / $67.23	Professional	26	$40.32	$46.71	$67.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $99.52 / $180.42 / $275.88	Professional	TC	$99.52	$180.42	$275.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $103.60 / $201.57 / $370.76	Professional		$103.60	$201.57	$370.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.26 / $59.82 / $92.06	Professional	26	$33.26	$59.82	$92.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.34 / $139.74 / $296.51	Professional	TC	$70.34	$139.74	$296.51
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $4.48 / $177.93 / $323.07	Professional		$4.48	$177.93	$323.07
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1.52 / $44.88 / $70.25	Professional	26	$1.52	$44.88	$70.25
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $2.96 / $133.03 / $208.22	Professional	TC	$2.96	$133.03	$208.22
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $3.36 / $154.72 / $232.08	Professional		$3.36	$154.72	$232.08
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1.13 / $39.03 / $58.55	Professional	26	$1.13	$39.03	$58.55
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $2.22 / $115.68 / $173.52	Professional	TC	$2.22	$115.68	$173.52
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 $161.35 / $228.53 / $317.08	Professional		$161.35	$228.53	$317.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.90 / $55.95 / $78.31	Professional	26	$40.90	$55.95	$78.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $120.75 / $170.54 / $238.76	Professional	TC	$120.75	$170.54	$238.76