Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $120.23 / $120.23 / $147.91	Facility	26	$120.23	$120.23	$147.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $758.58 / $1,819.70	Professional		$562.34	$758.58	$1,819.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $141.25 / $645.65	Professional	26	$112.20	$141.25	$645.65
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $218.78 / $218.78 / $549.54	Professional	52	$218.78	$218.78	$549.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $602.56 / $1,995.26	Professional	TC	$446.68	$602.56	$1,995.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $575.44 / $676.08	Professional		$537.03	$575.44	$676.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $114.82 / $147.91	Professional	26	$102.33	$114.82	$147.91
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $501.19 / $549.54	Professional	TC	$302.00	$501.19	$549.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $616.60 / $891.25	Professional		$524.81	$616.60	$891.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $120.23 / $177.83	Professional	26	$102.33	$120.23	$177.83
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $501.19 / $707.95	Professional	TC	$426.58	$501.19	$707.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $851.14 / $1,230.27	Professional		$588.84	$851.14	$1,230.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $173.78 / $257.04	Professional	26	$123.03	$173.78	$257.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $645.65 / $1,000.00	Professional	TC	$501.19	$645.65	$1,000.00
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $5.13 / $741.31 / $1,047.13	Professional		$5.13	$741.31	$1,047.13
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $2.29 / $131.83 / $186.21	Professional	26	$2.29	$131.83	$186.21
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $2.82 / $616.60 / $851.14	Professional	TC	$2.82	$616.60	$851.14
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $5.13 / $5.13 / $1,000.00	Professional		$5.13	$5.13	$1,000.00
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $2.29 / $2.29 / $177.83	Professional	26	$2.29	$2.29	$177.83
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $2.82 / $2.82 / $831.76	Professional	TC	$2.82	$2.82	$831.76
Select Health Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $676.08 / $1,023.29	Professional		$602.56	$676.08	$1,023.29
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $120.23 / $208.93	Professional	26	$112.20	$120.23	$208.93
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $549.54 / $812.83	Professional	TC	$489.78	$549.54	$812.83
United Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $831.76 / $1,122.02	Professional		$549.54	$831.76	$1,122.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $173.78 / $229.09	Professional	26	$112.20	$173.78	$229.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $676.08 / $912.01	Professional	TC	$467.74	$676.08	$912.01