Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $51.52 / $344.25 / $673.00	Facility		$51.52	$344.25	$673.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $12.53 / $33.69	Facility	26	$9.77	$12.53	$33.69
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $21.46 / $73.14 / $430.87	Facility	TC	$21.46	$73.14	$430.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.51 / $31.25 / $83.99	Professional		$22.51	$31.25	$83.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.22 / $9.77 / $25.57	Professional	26	$7.22	$9.77	$25.57
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $52.80 / $52.80 / $52.80	Professional	50	$52.80	$52.80	$52.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.29 / $21.46 / $60.32	Professional	TC	$15.29	$21.46	$60.32
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.85 / $35.88 / $81.83	Professional		$25.85	$35.88	$81.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.69 / $10.03 / $28.90	Professional	26	$6.69	$10.03	$28.90
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $38.77 / $40.93 / $122.75	Professional	50	$38.77	$40.93	$122.75
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $37.28 / $37.28 / $37.28	Professional	TC	$37.28	$37.28	$37.28
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $143.22 / $180.00 / $199.96	Facility		$143.22	$180.00	$199.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.64 / $49.39 / $69.84	Professional		$33.64	$49.39	$69.84
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.73 / $12.82 / $18.13	Professional	26	$8.73	$12.82	$18.13
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $50.46 / $74.08 / $104.77	Professional	50	$50.46	$74.08	$104.77
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $24.91 / $36.57 / $51.62	Professional	TC	$24.91	$36.57	$51.62
Cigna Facility/Professional Facility Modifier Low / Median / High Price $120.10 / $163.44 / $521.64	Facility		$120.10	$163.44	$521.64
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $168.49 / $168.49 / $168.49	Facility	TC	$168.49	$168.49	$168.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.37 / $64.98 / $107.14	Professional		$43.37	$64.98	$107.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.21 / $18.10 / $27.17	Professional	26	$11.21	$18.10	$27.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.43 / $45.63 / $79.98	Professional	TC	$32.43	$45.63	$79.98
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $38.51 / $68.44 / $126.86	Professional		$38.51	$68.44	$126.86
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $17.30 / $32.94	Professional	26	$10.00	$17.30	$32.94
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $28.51 / $49.32 / $93.91	Professional	TC	$28.51	$49.32	$93.91
United Facility/Professional Professional Modifier Low / Median / High Price $35.47 / $50.26 / $95.32	Professional		$35.47	$50.26	$95.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.82 / $12.25 / $24.15	Professional	26	$8.82	$12.25	$24.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.05 / $30.80 / $53.34	Professional	TC	$24.05	$30.80	$53.34
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $25.35 / $30.86 / $46.60	Professional		$25.35	$30.86	$46.60
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $7.28 / $8.64 / $11.82	Professional	26	$7.28	$8.64	$11.82
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $17.28 / $22.29 / $30.72	Professional	TC	$17.28	$22.29	$30.72