Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $323.59 / $630.96	Facility		$53.70	$323.59	$630.96
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $12.59 / $33.88	Facility	26	$9.77	$12.59	$33.88
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $21.38 / $60.26 / $389.05	Facility	TC	$21.38	$60.26	$389.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.33 / $30.90 / $93.33	Professional		$9.33	$30.90	$93.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.59 / $37.15	Professional	26	$7.94	$12.59	$37.15
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $35.48 / $114.82 / $234.42	Professional	50	$35.48	$114.82	$234.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $26.92 / $83.18	Professional	TC	$19.05	$26.92	$83.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $27.54 / $47.86	Professional		$23.44	$27.54	$47.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $11.22 / $28.84	Professional	26	$6.61	$11.22	$28.84
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $54.95 / $54.95 / $131.83	Professional	50	$54.95	$54.95	$131.83
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $20.42 / $48.98	Professional	TC	$17.38	$20.42	$48.98
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $199.53 / $223.87	Facility		$162.18	$199.53	$223.87
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $53.70 / $70.79	Professional		$35.48	$53.70	$70.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $14.13 / $20.42	Professional	26	$9.12	$14.13	$20.42
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $53.70 / $81.28 / $107.15	Professional	50	$53.70	$81.28	$107.15
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $39.81 / $52.48	Professional	TC	$26.92	$39.81	$52.48
Cigna Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $218.78 / $524.81	Facility		$120.23	$218.78	$524.81
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $169.82 / $169.82 / $169.82	Facility	TC	$169.82	$169.82	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $54.95 / $104.71	Professional		$41.69	$54.95	$104.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $18.20 / $26.92	Professional	26	$10.96	$18.20	$26.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $40.74 / $77.62	Professional	TC	$30.90	$40.74	$77.62
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $67.61 / $97.72	Professional		$41.69	$67.61	$97.72
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $16.22 / $23.99	Professional	26	$10.47	$16.22	$23.99
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $48.98 / $70.79	Professional	TC	$31.62	$48.98	$70.79
United Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $46.77 / $89.13	Professional		$33.88	$46.77	$89.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $12.59 / $23.99	Professional	26	$8.91	$12.59	$23.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $33.11 / $64.57	Professional	TC	$23.44	$33.11	$64.57
Well Sense Facility/Professional Facility Modifier Low / Median / High Price $27.54 / $27.54 / $27.54	Facility		$27.54	$27.54	$27.54
Well Sense Facility/Professional Facility Modifier 26 Low / Median / High Price $5.75 / $6.76 / $6.76	Facility	26	$5.75	$6.76	$6.76
Well Sense Facility/Professional Facility Modifier TC Low / Median / High Price $17.38 / $20.42 / $20.42	Facility	TC	$17.38	$20.42	$20.42