Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $160.87 / $3,551.77 / $4,110.12	Facility		$160.87	$3,551.77	$4,110.12
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.42 / $25.30 / $28.10	Facility	26	$23.42	$25.30	$28.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.82 / $178.25 / $696.02	Professional		$117.82	$178.25	$696.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.23 / $23.42 / $90.29	Professional	26	$19.23	$23.42	$90.29
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $58.91 / $67.03 / $357.34	Professional	52	$58.91	$67.03	$357.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $98.59 / $157.09 / $204.22	Professional	TC	$98.59	$157.09	$204.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.34 / $100.34 / $122.73	Professional		$100.34	$100.34	$122.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.86 / $43.86 / $43.86	Professional	26	$43.86	$43.86	$43.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.09 / $132.90 / $210.66	Professional		$128.09	$132.90	$210.66
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.98 / $22.49 / $27.52	Professional	26	$20.98	$22.49	$27.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $100.68 / $110.40 / $185.17	Professional	TC	$100.68	$110.40	$185.17
Cigna Facility/Professional Facility Modifier Low / Median / High Price $154.44 / $299.25 / $860.29	Facility		$154.44	$299.25	$860.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.35 / $182.75 / $266.58	Professional		$123.35	$182.75	$266.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.44 / $29.56 / $42.16	Professional	26	$20.44	$29.56	$42.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $103.67 / $155.06 / $230.40	Professional	TC	$103.67	$155.06	$230.40
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $3.65 / $159.86 / $233.14	Professional		$3.65	$159.86	$233.14
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1.36 / $24.21 / $36.84	Professional	26	$1.36	$24.21	$36.84
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $1.89 / $134.60 / $189.38	Professional	TC	$1.89	$134.60	$189.38
Hometown Health Facility/Professional Facility Modifier Low / Median / High Price $172.92 / $172.92 / $172.92	Facility		$172.92	$172.92	$172.92
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $3.65 / $125.42 / $199.83	Professional		$3.65	$125.42	$199.83
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1.53 / $21.05 / $31.58	Professional	26	$1.53	$21.05	$31.58
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $2.12 / $112.17 / $168.26	Professional	TC	$2.12	$112.17	$168.26
United Facility/Professional Professional Modifier Low / Median / High Price $125.01 / $190.38 / $294.29	Professional		$125.01	$190.38	$294.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.47 / $28.58 / $47.79	Professional	26	$20.47	$28.58	$47.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $105.58 / $162.36 / $260.22	Professional	TC	$105.58	$162.36	$260.22