Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $194.98 / $467.74	Facility		$100.00	$194.98	$467.74
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $32.36 / $39.81	Facility	26	$32.36	$32.36	$39.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $102.33 / $446.68	Professional		$67.61	$102.33	$446.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $60.26 / $181.97	Professional	26	$28.84	$60.26	$181.97
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $102.33 / $489.78 / $776.25	Professional	50	$102.33	$489.78	$776.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $58.88 / $309.03	Professional	TC	$43.65	$58.88	$309.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $66.07 / $100.00	Professional		$60.26	$66.07	$100.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $26.30 / $56.23	Professional	26	$23.99	$26.30	$56.23
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $83.18 / $100.00 / $190.55	Professional	50	$83.18	$100.00	$190.55
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $42.66 / $45.71	Professional	TC	$37.15	$42.66	$45.71
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $109.65 / $109.65	Facility		$69.18	$109.65	$109.65
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $102.33 / $154.88	Professional		$81.28	$102.33	$154.88
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $38.90 / $54.95	Professional	26	$30.20	$38.90	$54.95
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $114.82 / $138.04 / $162.18	Professional	50	$114.82	$138.04	$162.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $63.10 / $100.00	Professional	TC	$50.12	$63.10	$100.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $169.82 / $416.87	Facility		$52.48	$169.82	$416.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $109.65 / $162.18	Professional		$72.44	$109.65	$162.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $42.66 / $63.10	Professional	26	$27.54	$42.66	$63.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $67.61 / $102.33	Professional	TC	$44.67	$67.61	$102.33
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $0.72 / $95.50 / $138.04	Professional		$0.72	$95.50	$138.04
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $0.27 / $35.48 / $52.48	Professional	26	$0.27	$35.48	$52.48
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $0.45 / $60.26 / $87.10	Professional	TC	$0.45	$60.26	$87.10
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $0.72 / $0.72 / $125.89	Professional		$0.72	$0.72	$125.89
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $0.27 / $0.27 / $46.77	Professional	26	$0.27	$0.27	$46.77
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $0.45 / $0.45 / $77.62	Professional	TC	$0.45	$0.45	$77.62
Select Health Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $83.18 / $117.49	Professional		$81.28	$83.18	$117.49
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $30.90 / $46.77	Professional	26	$30.90	$30.90	$46.77
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $52.48 / $70.79	Professional	TC	$51.29	$52.48	$70.79
United Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $89.13 / $147.91	Professional		$72.44	$89.13	$147.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $34.67 / $56.23	Professional	26	$27.54	$34.67	$56.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $54.95 / $89.13	Professional	TC	$43.65	$54.95	$89.13