Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.25 / $76.39 / $200.16	Facility	26	$46.25	$76.39	$200.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.66 / $230.80 / $688.49	Professional		$134.66	$230.80	$688.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.00 / $46.25 / $129.60	Professional	26	$37.00	$46.25	$129.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.67 / $184.55 / $558.89	Professional	TC	$97.67	$184.55	$558.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $68.81 / $104.63 / $130.16	Professional		$68.81	$104.63	$130.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.79 / $53.37 / $149.75	Professional	26	$34.79	$53.37	$149.75
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $68.20 / $68.20 / $68.20	Professional	TC	$68.20	$68.20	$68.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $127.77 / $272.98 / $395.82	Professional		$127.77	$272.98	$395.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.29 / $96.75 / $136.82	Professional	26	$45.29	$96.75	$136.82
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $191.65 / $409.47 / $587.13	Professional	50	$191.65	$409.47	$587.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $82.48 / $176.23 / $252.69	Professional	TC	$82.48	$176.23	$252.69
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.41 / $64.41 / $64.41	Facility	26	$64.41	$64.41	$64.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $175.30 / $304.27 / $554.00	Professional		$175.30	$304.27	$554.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.02 / $95.85 / $139.97	Professional	26	$58.02	$95.85	$139.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $115.24 / $203.69 / $430.97	Professional	TC	$115.24	$203.69	$430.97
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $146.27 / $259.95 / $481.83	Professional		$146.27	$259.95	$481.83
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $51.84 / $89.67 / $170.77	Professional	26	$51.84	$89.67	$170.77
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $94.43 / $167.82 / $311.06	Professional	TC	$94.43	$167.82	$311.06
United Facility/Professional Professional Modifier Low / Median / High Price $194.78 / $235.36 / $415.45	Professional		$194.78	$235.36	$415.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.97 / $66.63 / $145.53	Professional	26	$49.97	$66.63	$145.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $132.63 / $159.15 / $354.69	Professional	TC	$132.63	$159.15	$354.69
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $123.64 / $170.13 / $239.00	Professional		$123.64	$170.13	$239.00
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $38.47 / $47.72 / $63.05	Professional	26	$38.47	$47.72	$63.05
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $85.17 / $102.20 / $189.82	Professional	TC	$85.17	$102.20	$189.82