Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.18 / $69.18 / $83.18	Facility	26	$69.18	$69.18	$83.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $275.42 / $436.52	Professional		$194.98	$275.42	$436.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $61.66 / $128.82	Professional	26	$51.29	$61.66	$128.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $194.98 / $354.81	Professional	TC	$141.25	$194.98	$354.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $128.82 / $194.98	Professional		$128.82	$128.82	$194.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $43.65 / $50.12	Professional	26	$42.66	$43.65	$50.12
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $234.42 / $346.74	Professional		$194.98	$234.42	$346.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $54.95 / $97.72	Professional	26	$53.70	$54.95	$97.72
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $169.82 / $288.40	Professional	TC	$138.04	$169.82	$288.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $338.84 / $549.54	Professional		$199.53	$338.84	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $72.44 / $109.65	Professional	26	$43.65	$72.44	$109.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $257.04 / $446.68	Professional	TC	$144.54	$257.04	$446.68
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $2.82 / $251.19 / $338.84	Professional		$2.82	$251.19	$338.84
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $0.63 / $66.07 / $89.13	Professional	26	$0.63	$66.07	$89.13
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $181.97 / $257.04	Professional	TC	$91.20	$181.97	$257.04
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $2.82 / $2.82 / $288.40	Professional		$2.82	$2.82	$288.40
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $0.63 / $0.63 / $83.18	Professional	26	$0.63	$0.63	$83.18
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $151.36 / $208.93	Professional	TC	$151.36	$151.36	$208.93
Select Health Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $194.98 / $194.98	Professional		$190.55	$194.98	$194.98
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $54.95 / $54.95	Professional	26	$54.95	$54.95	$54.95
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $138.04 / $138.04	Professional	TC	$138.04	$138.04	$138.04
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $288.40 / $467.74	Professional		$194.98	$288.40	$467.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $53.70 / $100.00	Professional	26	$43.65	$53.70	$100.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $204.17 / $398.11	Professional	TC	$138.04	$204.17	$398.11