Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.40 / $167.00 / $167.00	Facility	26	$124.40	$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 $111.76 / $145.65 / $202.15	Professional	26	$111.76	$145.65	$202.15
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $174.43 / $212.50 / $300.00	Professional	52	$174.43	$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 $353.33 / $457.25 / $671.06	Professional		$353.33	$457.25	$671.06
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $113.01 / $146.25 / $223.92	Professional	26	$113.01	$146.25	$223.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $235.97 / $310.17 / $447.14	Professional	TC	$235.97	$310.17	$447.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $432.71 / $661.83 / $1,255.65	Professional		$432.71	$661.83	$1,255.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.86 / $174.01 / $243.04	Professional	26	$112.86	$174.01	$243.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $291.66 / $461.94 / $1,120.83	Professional	TC	$291.66	$461.94	$1,120.83
Community Health Options Facility/Professional Professional Modifier Low / Median / High Price $395.00 / $395.00 / $395.00	Professional		$395.00	$395.00	$395.00
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $400.25 / $481.64 / $868.86	Professional		$400.25	$481.64	$868.86
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $133.55 / $160.71 / $289.91	Professional	26	$133.55	$160.71	$289.91
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $266.69 / $320.93 / $578.92	Professional	TC	$266.69	$320.93	$578.92
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $124.40 / $151.53 / $167.00	Facility	26	$124.40	$151.53	$167.00
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $383.95 / $554.49 / $838.23	Professional		$383.95	$554.49	$838.23
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $124.40 / $167.00 / $251.00	Professional	26	$124.40	$167.00	$251.00
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $174.43 / $216.50 / $300.00	Professional	52	$174.43	$216.50	$300.00
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $253.73 / $380.61 / $489.28	Professional	TC	$253.73	$380.61	$489.28
United Facility/Professional Professional Modifier Low / Median / High Price $343.55 / $513.74 / $920.35	Professional		$343.55	$513.74	$920.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $113.18 / $163.74 / $277.08	Professional	26	$113.18	$163.74	$277.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $230.37 / $372.24 / $736.57	Professional	TC	$230.37	$372.24	$736.57