Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $606.16 / $8,965.00	Facility		$100.00	$606.16	$8,965.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.60 / $176.20 / $176.20	Facility	26	$62.60	$176.20	$176.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $122.08 / $195.17 / $432.23	Professional		$122.08	$195.17	$432.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.79 / $59.02 / $82.40	Professional	26	$40.79	$59.02	$82.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.29 / $136.13 / $349.82	Professional	TC	$81.29	$136.13	$349.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.87 / $325.33 / $475.46	Professional		$204.87	$325.33	$475.46
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.94 / $74.40 / $111.69	Professional	26	$40.94	$74.40	$111.69
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $129.88 / $248.90 / $362.30	Professional	TC	$129.88	$248.90	$362.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $222.97 / $436.45 / $659.82	Professional		$222.97	$436.45	$659.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.56 / $86.06 / $163.85	Professional	26	$49.56	$86.06	$163.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $166.45 / $350.39 / $529.72	Professional	TC	$166.45	$350.39	$529.72
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $184.41 / $365.83 / $607.46	Professional		$184.41	$365.83	$607.46
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $43.33 / $85.96 / $142.72	Professional	26	$43.33	$85.96	$142.72
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $141.08 / $279.87 / $464.73	Professional	TC	$141.08	$279.87	$464.73
United Facility/Professional Facility Modifier Low / Median / High Price $7,448.00 / $7,448.00 / $7,448.00	Facility		$7,448.00	$7,448.00	$7,448.00
United Facility/Professional Professional Modifier Low / Median / High Price $227.69 / $372.45 / $780.39	Professional		$227.69	$372.45	$780.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.91 / $79.29 / $257.60	Professional	26	$54.91	$79.29	$257.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $168.66 / $216.22 / $402.84	Professional	TC	$168.66	$216.22	$402.84
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $131.29 / $153.35 / $231.60	Professional		$131.29	$153.35	$231.60
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $31.30 / $38.69 / $76.66	Professional	26	$31.30	$38.69	$76.66
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $96.67 / $116.79 / $160.97	Professional	TC	$96.67	$116.79	$160.97