Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.25 / $116.25 / $125.55	Facility	26	$116.25	$116.25	$125.55
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $161.69 / $161.69 / $174.64	Facility	53	$161.69	$161.69	$174.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $731.63 / $1,191.97 / $4,692.45	Professional		$731.63	$1,191.97	$4,692.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $116.25 / $207.93 / $680.92	Professional	26	$116.25	$207.93	$680.92
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $316.98 / $404.25 / $2,346.23	Professional	52	$316.98	$404.25	$2,346.23
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $126.79 / $161.69 / $938.49	Professional	53	$126.79	$161.69	$938.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $564.08 / $767.25 / $1,175.16	Professional	TC	$564.08	$767.25	$1,175.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $740.41 / $803.25 / $1,318.51	Professional		$740.41	$803.25	$1,318.51
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $101.09 / $172.59 / $194.72	Professional	26	$101.09	$172.59	$194.72
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $611.16 / $669.06 / $1,130.80	Professional	TC	$611.16	$669.06	$1,130.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $770.15 / $1,084.90 / $1,475.20	Professional		$770.15	$1,084.90	$1,475.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $122.06 / $186.00 / $289.05	Professional	26	$122.06	$186.00	$289.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $619.46 / $880.05 / $1,246.04	Professional	TC	$619.46	$880.05	$1,246.04
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $6.30 / $1,008.00 / $1,285.08	Professional		$6.30	$1,008.00	$1,285.08
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1.30 / $159.15 / $218.83	Professional	26	$1.30	$159.15	$218.83
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $6.25 / $822.82 / $1,083.36	Professional	TC	$6.25	$822.82	$1,083.36
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $6.30 / $675.37 / $1,204.77	Professional		$6.30	$675.37	$1,204.77
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1.30 / $117.50 / $176.25	Professional	26	$1.30	$117.50	$176.25
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $5.00 / $779.78 / $1,028.52	Professional	TC	$5.00	$779.78	$1,028.52
United Facility/Professional Professional Modifier Low / Median / High Price $796.44 / $1,093.50 / $1,635.87	Professional		$796.44	$1,093.50	$1,635.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $195.17 / $269.20	Professional	26	$123.03	$195.17	$269.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $656.93 / $930.92 / $1,408.27	Professional	TC	$656.93	$930.92	$1,408.27