Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $167.00 / $167.00 / $167.00	Facility	26	$167.00	$167.00	$167.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $370.50 / $475.00 / $600.00	Professional		$370.50	$475.00	$600.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $111.15 / $140.00 / $167.00	Professional	26	$111.15	$140.00	$167.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $148.16 / $212.50 / $300.00	Professional	52	$148.16	$212.50	$300.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $259.35 / $335.00 / $433.00	Professional	TC	$259.35	$335.00	$433.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $299.32 / $387.36 / $569.47	Professional		$299.32	$387.36	$569.47
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $88.32 / $114.30 / $173.47	Professional	26	$88.32	$114.30	$173.47
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $208.49 / $272.70 / $396.00	Professional	TC	$208.49	$272.70	$396.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $365.75 / $560.95 / $943.28	Professional		$365.75	$560.95	$943.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.57 / $135.38 / $189.34	Professional	26	$85.57	$135.38	$189.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $256.19 / $380.97 / $773.10	Professional	TC	$256.19	$380.97	$773.10
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $339.65 / $408.72 / $737.31	Professional		$339.65	$408.72	$737.31
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $103.46 / $124.50 / $224.59	Professional	26	$103.46	$124.50	$224.59
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $236.19 / $284.22 / $512.72	Professional	TC	$236.19	$284.22	$512.72
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $327.07 / $522.16 / $1,008.00	Professional		$327.07	$522.16	$1,008.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $93.30 / $154.00 / $207.53	Professional	26	$93.30	$154.00	$207.53
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $148.16 / $212.50 / $300.00	Professional	52	$148.16	$212.50	$300.00
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $233.76 / $365.07 / $501.09	Professional	TC	$233.76	$365.07	$501.09
United Facility/Professional Professional Modifier Low / Median / High Price $290.19 / $434.32 / $778.77	Professional		$290.19	$434.32	$778.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $88.06 / $127.20 / $224.59	Professional	26	$88.06	$127.20	$224.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $202.13 / $326.62 / $518.79	Professional	TC	$202.13	$326.62	$518.79