Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $149.35 / $170.01 / $269.20	Facility		$149.35	$170.01	$269.20
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.16 / $47.22 / $50.59	Facility	26	$42.16	$47.22	$50.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $144.91 / $211.82 / $558.00	Professional		$144.91	$211.82	$558.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.86 / $55.46 / $219.07	Professional	26	$38.86	$55.46	$219.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.99 / $155.91 / $188.42	Professional	TC	$99.99	$155.91	$188.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $124.28 / $124.28 / $270.81	Professional		$124.28	$124.28	$270.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $80.73 / $80.73 / $80.73	Professional	26	$80.73	$80.73	$80.73
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,982.00 / $3,345.00 / $3,925.00	Facility		$2,982.00	$3,345.00	$3,925.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.75 / $211.53 / $274.73	Professional		$134.75	$211.53	$274.73
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.65 / $56.01 / $73.17	Professional	26	$35.65	$56.01	$73.17
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $100.63 / $153.72 / $205.17	Professional	TC	$100.63	$153.72	$205.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $135.55 / $212.87 / $306.54	Professional		$135.55	$212.87	$306.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.17 / $59.19 / $85.23	Professional	26	$41.17	$59.19	$85.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.10 / $153.69 / $221.31	Professional	TC	$97.10	$153.69	$221.31
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $13.07 / $172.04 / $235.57	Professional		$13.07	$172.04	$235.57
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $0.57 / $46.24 / $60.88	Professional	26	$0.57	$46.24	$60.88
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $12.49 / $125.11 / $171.23	Professional	TC	$12.49	$125.11	$171.23
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 $13.07 / $124.28 / $211.59	Professional		$13.07	$124.28	$211.59
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $0.57 / $38.53 / $57.80	Professional	26	$0.57	$38.53	$57.80
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $12.49 / $102.53 / $153.80	Professional	TC	$12.49	$102.53	$153.80
United Facility/Professional Professional Modifier Low / Median / High Price $149.76 / $223.79 / $316.25	Professional		$149.76	$223.79	$316.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.33 / $60.14 / $84.26	Professional	26	$40.33	$60.14	$84.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $110.47 / $153.99 / $234.49	Professional	TC	$110.47	$153.99	$234.49