Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.65 / $127.50 / $247.02	Facility	26	$93.65	$127.50	$247.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $332.30 / $425.00 / $1,320.50	Professional		$332.30	$425.00	$1,320.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.32 / $127.50 / $247.02	Professional	26	$90.32	$127.50	$247.02
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $166.15 / $200.00 / $300.00	Professional	52	$166.15	$200.00	$300.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $241.98 / $297.50 / $931.29	Professional	TC	$241.98	$297.50	$931.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $154.13 / $164.39 / $487.42	Professional		$154.13	$164.39	$487.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.37 / $51.65 / $204.25	Professional	26	$47.37	$51.65	$204.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $200.55 / $428.48 / $614.39	Professional		$200.55	$428.48	$614.39
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.78 / $132.00 / $186.67	Professional	26	$61.78	$132.00	$186.67
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $300.82 / $642.72 / $921.59	Professional	50	$300.82	$642.72	$921.59
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.77 / $296.48 / $425.12	Professional	TC	$138.77	$296.48	$425.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.58 / $64.58 / $64.58	Facility	26	$64.58	$64.58	$64.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $276.33 / $476.81 / $1,026.13	Professional		$276.33	$476.81	$1,026.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.34 / $131.63 / $190.99	Professional	26	$77.34	$131.63	$190.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $193.53 / $335.58 / $888.46	Professional	TC	$193.53	$335.58	$888.46
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $229.59 / $408.03 / $756.29	Professional		$229.59	$408.03	$756.29
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $70.73 / $125.43 / $232.99	Professional	26	$70.73	$125.43	$232.99
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $158.86 / $282.33 / $523.29	Professional	TC	$158.86	$282.33	$523.29
United Facility/Professional Professional Modifier Low / Median / High Price $289.26 / $349.52 / $653.44	Professional		$289.26	$349.52	$653.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.23 / $118.52 / $197.00	Professional	26	$67.23	$118.52	$197.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $203.92 / $244.69 / $517.28	Professional	TC	$203.92	$244.69	$517.28
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $265.83 / $358.87 / $503.48	Professional		$265.83	$358.87	$503.48
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $52.46 / $62.29 / $85.07	Professional	26	$52.46	$62.29	$85.07
Well Sense Facility/Professional Professional Modifier 52 Low / Median / High Price $108.48 / $130.18 / $146.44	Professional	52	$108.48	$130.18	$146.44
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $211.45 / $255.59 / $411.31	Professional	TC	$211.45	$255.59	$411.31