Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.35 / $127.50 / $292.61	Facility	26	$105.35	$127.50	$292.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $313.26 / $425.00 / $1,320.50	Professional		$313.26	$425.00	$1,320.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.79 / $127.50 / $292.61	Professional	26	$97.79	$127.50	$292.61
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $156.63 / $200.00 / $300.00	Professional	52	$156.63	$200.00	$300.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $215.47 / $297.50 / $931.29	Professional	TC	$215.47	$297.50	$931.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $101.23 / $153.57 / $455.33	Professional		$101.23	$153.57	$455.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.80 / $56.52 / $223.45	Professional	26	$51.80	$56.52	$223.45
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $99.20 / $99.20 / $99.20	Professional	TC	$99.20	$99.20	$99.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $187.61 / $400.84 / $581.21	Professional		$187.61	$400.84	$581.21
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.59 / $144.44 / $204.26	Professional	26	$67.59	$144.44	$204.26
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $120.01 / $256.39 / $370.41	Professional	TC	$120.01	$256.39	$370.41
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.44 / $108.44 / $108.44	Facility	26	$108.44	$108.44	$108.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $257.14 / $447.18 / $1,066.81	Professional		$257.14	$447.18	$1,066.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.58 / $143.55 / $209.97	Professional	26	$86.58	$143.55	$209.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $167.40 / $295.95 / $891.95	Professional	TC	$167.40	$295.95	$891.95
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $214.77 / $380.87 / $707.47	Professional		$214.77	$380.87	$707.47
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $77.39 / $137.54 / $254.93	Professional	26	$77.39	$137.54	$254.93
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $137.38 / $244.15 / $452.54	Professional	TC	$137.38	$244.15	$452.54
United Facility/Professional Professional Modifier Low / Median / High Price $272.81 / $351.24 / $685.17	Professional		$272.81	$351.24	$685.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $76.15 / $98.39 / $198.35	Professional	26	$76.15	$98.39	$198.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $180.48 / $216.54 / $509.45	Professional	TC	$180.48	$216.54	$509.45
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $263.11 / $355.20 / $498.33	Professional		$263.11	$355.20	$498.33
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $57.16 / $70.88 / $92.27	Professional	26	$57.16	$70.88	$92.27
Well Sense Facility/Professional Professional Modifier 52 Low / Median / High Price $112.13 / $134.56 / $151.38	Professional	52	$112.13	$134.56	$151.38
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $204.47 / $247.14 / $390.07	Professional	TC	$204.47	$247.14	$390.07