Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $58.03 / $134.15 / $655.20	Facility		$58.03	$134.15	$655.20
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.74 / $16.14 / $21.03	Facility	26	$11.74	$16.14	$21.03
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.89 / $52.13 / $429.31	Facility	TC	$28.89	$52.13	$429.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.28 / $38.29 / $45.58	Professional		$31.28	$38.29	$45.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.68 / $10.36 / $13.95	Professional	26	$8.68	$10.36	$13.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.60 / $27.48 / $37.42	Professional	TC	$22.60	$27.48	$37.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.92 / $10.17 / $24.41	Professional	26	$7.92	$10.17	$24.41
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $66.84 / $66.84 / $66.84	Professional	TC	$66.84	$66.84	$66.84
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $170.84 / $214.70 / $238.51	Facility		$170.84	$214.70	$238.51
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.11 / $58.89 / $83.28	Professional		$40.11	$58.89	$83.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.35 / $15.20 / $21.49	Professional	26	$10.35	$15.20	$21.49
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $60.16 / $88.33 / $124.92	Professional	50	$60.16	$88.33	$124.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.76 / $43.69 / $61.78	Professional	TC	$29.76	$43.69	$61.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $143.53 / $215.66 / $640.01	Facility		$143.53	$215.66	$640.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.23 / $84.49 / $126.56	Professional		$51.23	$84.49	$126.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.54 / $21.70 / $32.04	Professional	26	$13.54	$21.70	$32.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.26 / $59.76 / $94.51	Professional	TC	$38.26	$59.76	$94.51
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $45.92 / $81.61 / $151.27	Professional		$45.92	$81.61	$151.27
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $11.85 / $20.50 / $39.04	Professional	26	$11.85	$20.50	$39.04
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $34.07 / $58.93 / $112.23	Professional	TC	$34.07	$58.93	$112.23
United Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $52.55 / $163.38	Professional		$41.69	$52.55	$163.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.09 / $14.02 / $29.53	Professional	26	$12.09	$14.02	$29.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.60 / $37.33 / $76.93	Professional	TC	$29.60	$37.33	$76.93
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $31.83 / $38.86 / $56.15	Professional		$31.83	$38.86	$56.15
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $8.69 / $10.43 / $14.91	Professional	26	$8.69	$10.43	$14.91
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $22.98 / $27.03 / $37.72	Professional	TC	$22.98	$27.03	$37.72