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 $331.78 / $425.00 / $1,320.50	Professional		$331.78	$425.00	$1,320.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.80 / $127.50 / $247.02	Professional	26	$89.80	$127.50	$247.02
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $475.00 / $475.00 / $475.00	Professional	50	$475.00	$475.00	$475.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $165.89 / $200.00 / $300.00	Professional	52	$165.89	$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 $107.72 / $164.12 / $486.62	Professional		$107.72	$164.12	$486.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.37 / $51.65 / $204.25	Professional	26	$47.37	$51.65	$204.25
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $114.41 / $114.41 / $114.41	Professional	TC	$114.41	$114.41	$114.41
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $200.22 / $427.79 / $613.40	Professional		$200.22	$427.79	$613.40
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 $300.33 / $641.67 / $920.11	Professional	50	$300.33	$641.67	$920.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.44 / $295.79 / $424.13	Professional	TC	$138.44	$295.79	$424.13
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 $275.87 / $476.04 / $1,026.13	Professional		$275.87	$476.04	$1,026.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.34 / $130.05 / $190.99	Professional	26	$77.34	$130.05	$190.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $193.07 / $333.59 / $888.46	Professional	TC	$193.07	$333.59	$888.46
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $229.22 / $407.37 / $755.07	Professional		$229.22	$407.37	$755.07
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $70.73 / $125.70 / $232.99	Professional	26	$70.73	$125.70	$232.99
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $281.67 / $522.08	Professional	TC	$158.49	$281.67	$522.08
United Facility/Professional Professional Modifier Low / Median / High Price $287.95 / $406.90 / $724.21	Professional		$287.95	$406.90	$724.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.57 / $89.64 / $184.11	Professional	26	$61.57	$89.64	$184.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $203.91 / $246.40 / $563.89	Professional	TC	$203.91	$246.40	$563.89
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $265.05 / $357.82 / $502.00	Professional		$265.05	$357.82	$502.00
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $51.69 / $61.95 / $83.81	Professional	26	$51.69	$61.95	$83.81
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 / $420.11	Professional	TC	$211.45	$255.59	$420.11