Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.24 / $15.24 / $27.35	Facility	26	$15.24	$15.24	$27.35
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $34.82 / $49.75 / $307.89	Facility	TC	$34.82	$49.75	$307.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.46 / $50.07 / $92.12	Professional		$38.46	$50.07	$92.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.20 / $14.02 / $27.43	Professional	26	$11.20	$14.02	$27.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.26 / $34.82 / $76.17	Professional	TC	$27.26	$34.82	$76.17
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.13 / $55.93 / $55.93	Professional		$40.13	$55.93	$55.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.80 / $17.52 / $44.97	Professional	26	$10.80	$17.52	$44.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.40 / $76.93 / $108.79	Professional		$52.40	$76.93	$108.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.59 / $19.95 / $28.21	Professional	26	$13.59	$19.95	$28.21
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $78.59 / $115.39 / $163.19	Professional	50	$78.59	$115.39	$163.19
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.82 / $56.99 / $80.59	Professional	TC	$38.82	$56.99	$80.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.95 / $104.19 / $165.41	Professional		$66.95	$104.19	$165.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.79 / $28.51 / $42.09	Professional	26	$17.79	$28.51	$42.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.92 / $72.53 / $123.32	Professional	TC	$49.92	$72.53	$123.32
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $62.52 / $114.57 / $213.44	Professional		$62.52	$114.57	$213.44
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $15.55 / $26.90 / $51.22	Professional	26	$15.55	$26.90	$51.22
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $44.44 / $78.98 / $146.38	Professional	TC	$44.44	$78.98	$146.38
United Facility/Professional Professional Modifier Low / Median / High Price $57.96 / $70.75 / $176.85	Professional		$57.96	$70.75	$176.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.60 / $19.71 / $40.83	Professional	26	$15.60	$19.71	$40.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.53 / $48.79 / $93.52	Professional	TC	$37.53	$48.79	$93.52
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $38.86 / $48.48 / $73.22	Professional		$38.86	$48.48	$73.22
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $11.34 / $13.34 / $19.25	Professional	26	$11.34	$13.34	$19.25
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $26.98 / $34.61 / $48.46	Professional	TC	$26.98	$34.61	$48.46