Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.47 / $141.65 / $151.76	Facility	26	$126.47	$141.65	$151.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $605.22 / $797.72 / $3,133.60	Professional		$605.22	$797.72	$3,133.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.68 / $137.93 / $576.00	Professional	26	$117.68	$137.93	$576.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $294.64 / $342.47 / $480.85	Professional	52	$294.64	$342.47	$480.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $481.29 / $654.21 / $927.64	Professional	TC	$481.29	$654.21	$927.64
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $635.91 / $635.91 / $635.91	Professional		$635.91	$635.91	$635.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $158.35 / $158.35 / $158.35	Professional	26	$158.35	$158.35	$158.35
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $590.10 / $649.28 / $867.00	Professional		$590.10	$649.28	$867.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $104.95 / $124.94 / $154.19	Professional	26	$104.95	$124.94	$154.19
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $477.55 / $524.34 / $712.81	Professional	TC	$477.55	$524.34	$712.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $595.07 / $856.58 / $1,271.83	Professional		$595.07	$856.58	$1,271.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $119.09 / $170.13 / $244.23	Professional	26	$119.09	$170.13	$244.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $491.48 / $705.48 / $1,022.65	Professional	TC	$491.48	$705.48	$1,022.65
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $5.00 / $784.21 / $1,082.46	Professional		$5.00	$784.21	$1,082.46
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $2.50 / $141.84 / $194.88	Professional	26	$2.50	$141.84	$194.88
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $2.50 / $644.22 / $893.75	Professional	TC	$2.50	$644.22	$893.75
Hometown Health Facility/Professional Professional Modifier Low / Median / High Price $5.00 / $635.91 / $1,061.24	Professional		$5.00	$635.91	$1,061.24
Hometown Health Facility/Professional Professional Modifier 26 Low / Median / High Price $2.50 / $123.34 / $185.01	Professional	26	$2.50	$123.34	$185.01
Hometown Health Facility/Professional Professional Modifier TC Low / Median / High Price $2.50 / $584.15 / $876.23	Professional	TC	$2.50	$584.15	$876.23
United Facility/Professional Professional Modifier Low / Median / High Price $622.79 / $889.20 / $1,222.64	Professional		$622.79	$889.20	$1,222.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $116.57 / $176.98 / $243.44	Professional	26	$116.57	$176.98	$243.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $494.08 / $720.00 / $979.20	Professional	TC	$494.08	$720.00	$979.20