Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.03 / $184.37 / $506.79	Facility		$38.03	$184.37	$506.79
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.30 / $21.30 / $23.86	Facility	26	$21.30	$21.30	$23.86
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $16.73 / $73.27 / $486.15	Facility	TC	$16.73	$73.27	$486.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.82 / $73.08 / $225.10	Professional		$37.82	$73.08	$225.10
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $71.59 / $71.59 / $71.59	Professional	25	$71.59	$71.59	$71.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.52 / $24.48 / $64.73	Professional	26	$19.52	$24.48	$64.73
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $234.74 / $234.74 / $234.74	Professional	50	$234.74	$234.74	$234.74
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $17.47 / $21.30 / $120.52	Professional	52	$17.47	$21.30	$120.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.41 / $53.22 / $115.00	Professional	TC	$15.41	$53.22	$115.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $31.25 / $58.65 / $68.27	Professional		$31.25	$58.65	$68.27
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.69 / $20.38 / $34.47	Professional	26	$16.69	$20.38	$34.47
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $41.25 / $49.51 / $87.97	Professional	50	$41.25	$49.51	$87.97
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $14.56 / $26.43 / $42.52	Professional	TC	$14.56	$26.43	$42.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.85 / $68.45 / $109.32	Professional		$36.85	$68.45	$109.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.94 / $28.42 / $39.04	Professional	26	$18.94	$28.42	$39.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.73 / $43.14 / $75.29	Professional	TC	$16.73	$43.14	$75.29
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $1.15 / $54.75 / $94.00	Professional		$1.15	$54.75	$94.00
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $0.65 / $26.43 / $34.32	Professional	26	$0.65	$26.43	$34.32
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $0.51 / $24.66 / $61.40	Professional	TC	$0.51	$24.66	$61.40
Hometown Health Facility/Professional Facility Modifier Low / Median / High Price $142.46 / $142.46 / $142.46	Facility		$142.46	$142.46	$142.46
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $1.15 / $35.47 / $55.49	Professional		$1.15	$35.47	$55.49
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $0.65 / $20.32 / $30.50	Professional	26	$0.65	$20.32	$30.50
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $0.51 / $16.66 / $24.99	Professional	TC	$0.51	$16.66	$24.99
United Facility/Professional Professional Modifier Low / Median / High Price $44.45 / $71.11 / $105.74	Professional		$44.45	$71.11	$105.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.34 / $26.63 / $40.86	Professional	26	$19.34	$26.63	$40.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.12 / $43.40 / $73.77	Professional	TC	$21.12	$43.40	$73.77