Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.05 / $167.00 / $167.00	Facility	26	$80.05	$167.00	$167.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $95.46 / $97.76 / $105.77	Facility	53	$95.46	$97.76	$105.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $323.13 / $475.00 / $600.00	Professional		$323.13	$475.00	$600.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.06 / $140.00 / $167.00	Professional	26	$76.06	$140.00	$167.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $106.96 / $212.50 / $300.00	Professional	52	$106.96	$212.50	$300.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $225.34 / $335.00 / $433.00	Professional	TC	$225.34	$335.00	$433.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $216.38 / $280.02 / $413.28	Professional		$216.38	$280.02	$413.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $73.37 / $94.95 / $143.75	Professional	26	$73.37	$94.95	$143.75
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $141.72 / $184.54 / $269.52	Professional	TC	$141.72	$184.54	$269.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.60 / $402.33 / $924.14	Professional		$263.60	$402.33	$924.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.81 / $112.82 / $157.52	Professional	26	$70.81	$112.82	$157.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $173.03 / $274.12 / $647.00	Professional	TC	$173.03	$274.12	$647.00
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $246.50 / $296.62 / $535.10	Professional		$246.50	$296.62	$535.10
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $85.74 / $103.18 / $186.12	Professional	26	$85.74	$103.18	$186.12
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $160.76 / $193.45 / $348.98	Professional	TC	$160.76	$193.45	$348.98
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $80.05 / $97.50 / $167.00	Facility	26	$80.05	$97.50	$167.00
Martin's Point Facility/Professional Facility Modifier 53 Low / Median / High Price $95.46 / $97.76 / $105.77	Facility	53	$95.46	$97.76	$105.77
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $238.08 / $475.00 / $600.00	Professional		$238.08	$475.00	$600.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $77.22 / $140.00 / $175.42	Professional	26	$77.22	$140.00	$175.42
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $113.57 / $212.50 / $300.00	Professional	52	$113.57	$212.50	$300.00
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $159.12 / $335.00 / $433.00	Professional	TC	$159.12	$335.00	$433.00
United Facility/Professional Professional Modifier Low / Median / High Price $225.76 / $313.83 / $562.14	Professional		$225.76	$313.83	$562.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.20 / $105.72 / $187.27	Professional	26	$75.20	$105.72	$187.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $150.49 / $221.36 / $374.87	Professional	TC	$150.49	$221.36	$374.87