Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $1,749.77 / $9,859.00	Facility		$100.00	$1,749.77	$9,859.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $199.25 / $199.25 / $199.25	Facility	26	$199.25	$199.25	$199.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $341.43 / $476.50 / $481.75	Professional		$341.43	$476.50	$481.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $127.31 / $179.65 / $179.65	Professional	26	$127.31	$179.65	$179.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $214.11 / $296.85 / $319.08	Professional	TC	$214.11	$296.85	$319.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $426.98 / $702.93 / $1,027.30	Professional		$426.98	$702.93	$1,027.30
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $129.03 / $235.26 / $356.11	Professional	26	$129.03	$235.26	$356.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $236.79 / $459.25 / $671.18	Professional	TC	$236.79	$459.25	$671.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $464.69 / $870.88 / $1,316.58	Professional		$464.69	$870.88	$1,316.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $157.74 / $265.05 / $410.26	Professional	26	$157.74	$265.05	$410.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $306.95 / $578.28 / $906.32	Professional	TC	$306.95	$578.28	$906.32
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $398.44 / $790.43 / $1,312.50	Professional		$398.44	$790.43	$1,312.50
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $138.12 / $274.00 / $454.98	Professional	26	$138.12	$274.00	$454.98
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $260.32 / $516.41 / $857.52	Professional	TC	$260.32	$516.41	$857.52
United Facility/Professional Facility Modifier Low / Median / High Price $8,035.00 / $8,035.00 / $8,035.00	Facility		$8,035.00	$8,035.00	$8,035.00
United Facility/Professional Professional Modifier Low / Median / High Price $499.88 / $661.42 / $1,232.31	Professional		$499.88	$661.42	$1,232.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $173.30 / $213.30 / $413.93	Professional	26	$173.30	$213.30	$413.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $301.70 / $439.25 / $818.38	Professional	TC	$301.70	$439.25	$818.38
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $237.49 / $352.58 / $532.50	Professional		$237.49	$352.58	$532.50
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $95.89 / $113.61 / $159.04	Professional	26	$95.89	$113.61	$159.04
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $189.08 / $236.36 / $326.94	Professional	TC	$189.08	$236.36	$326.94