Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.67 / $127.50 / $266.88	Facility	26	$101.67	$127.50	$266.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $400.00 / $475.00 / $1,320.50	Professional		$400.00	$475.00	$1,320.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $96.88 / $127.50 / $266.88	Professional	26	$96.88	$127.50	$266.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $185.25 / $212.50 / $300.00	Professional	52	$185.25	$212.50	$300.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.41 / $335.00 / $931.29	Professional	TC	$281.41	$335.00	$931.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $184.09 / $545.84 / $545.84	Professional		$184.09	$545.84	$545.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.33 / $53.59 / $157.30	Professional	26	$53.33	$53.59	$157.30
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $130.50 / $130.50 / $130.50	Professional	TC	$130.50	$130.50	$130.50
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $224.48 / $479.62 / $695.44	Professional		$224.48	$479.62	$695.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.63 / $142.37 / $201.33	Professional	26	$66.63	$142.37	$201.33
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $157.85 / $337.26 / $489.02	Professional	TC	$157.85	$337.26	$489.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $310.66 / $554.89 / $1,116.26	Professional		$310.66	$554.89	$1,116.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.05 / $141.36 / $205.91	Professional	26	$84.05	$141.36	$205.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $220.54 / $398.00 / $972.18	Professional	TC	$220.54	$398.00	$972.18
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $256.99 / $456.72 / $846.55	Professional		$256.99	$456.72	$846.55
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $76.28 / $135.28 / $251.27	Professional	26	$76.28	$135.28	$251.27
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $180.71 / $321.16 / $595.28	Professional	TC	$180.71	$321.16	$595.28
United Facility/Professional Professional Modifier Low / Median / High Price $335.09 / $490.38 / $2,373.58	Professional		$335.09	$490.38	$2,373.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.70 / $98.59 / $198.34	Professional	26	$66.70	$98.59	$198.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $244.08 / $292.86 / $838.25	Professional	TC	$244.08	$292.86	$838.25
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $296.77 / $408.36 / $562.08	Professional		$296.77	$408.36	$562.08
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $55.94 / $67.05 / $90.70	Professional	26	$55.94	$67.05	$90.70
Well Sense Facility/Professional Professional Modifier 52 Low / Median / High Price $109.90 / $131.88 / $148.37	Professional	52	$109.90	$131.88	$148.37
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $240.43 / $288.52 / $455.37	Professional	TC	$240.43	$288.52	$455.37