Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $117.49 / $141.25	Facility	26	$117.49	$117.49	$141.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $478.63 / $1,230.27	Professional		$199.53	$478.63	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $128.82 / $323.59	Professional	26	$70.79	$128.82	$323.59
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $199.53 / $199.53 / $199.53	Professional	52	$199.53	$199.53	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $239.88 / $562.34	Professional	TC	$123.03	$239.88	$562.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $147.91 / $190.55	Professional		$125.89	$147.91	$190.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $56.23 / $104.71	Professional	26	$52.48	$56.23	$104.71
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $93.33 / $100.00	Professional	TC	$79.43	$93.33	$100.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $229.09 / $398.11	Professional		$190.55	$229.09	$398.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $70.79 / $117.49	Professional	26	$66.07	$70.79	$117.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $151.36 / $323.59	Professional	TC	$123.03	$151.36	$323.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $346.74 / $691.83	Professional		$190.55	$346.74	$691.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $93.33 / $134.90	Professional	26	$53.70	$93.33	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $239.88 / $588.84	Professional	TC	$125.89	$239.88	$588.84
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $4.90 / $245.47 / $331.13	Professional		$4.90	$245.47	$331.13
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $0.89 / $81.28 / $109.65	Professional	26	$0.89	$81.28	$109.65
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $165.96 / $263.03	Professional	TC	$95.50	$165.96	$263.03
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $4.90 / $4.90 / $288.40	Professional		$4.90	$4.90	$288.40
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $0.89 / $0.89 / $102.33	Professional	26	$0.89	$0.89	$102.33
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $181.97 / $190.55	Professional	TC	$181.97	$181.97	$190.55
Select Health Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $190.55 / $190.55	Professional		$186.21	$190.55	$190.55
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $67.61 / $67.61	Professional	26	$67.61	$67.61	$67.61
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $123.03 / $123.03	Professional	TC	$120.23	$123.03	$123.03
United Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $295.12 / $616.60	Professional		$186.21	$295.12	$616.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $66.07 / $125.89	Professional	26	$57.54	$66.07	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $173.78 / $537.03	Professional	TC	$114.82	$173.78	$537.03