Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $168.18 / $450.08 / $450.08	Facility	26	$168.18	$450.08	$450.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $298.91 / $414.14 / $1,282.83	Professional		$298.91	$414.14	$1,282.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $88.28 / $109.96 / $308.05	Professional	26	$88.28	$109.96	$308.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $210.62 / $309.76 / $974.77	Professional	TC	$210.62	$309.76	$974.77
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $310.35 / $693.50 / $693.50	Professional		$310.35	$693.50	$693.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $82.72 / $90.37 / $255.16	Professional	26	$82.72	$90.37	$255.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $285.94 / $864.57 / $1,222.67	Professional		$285.94	$864.57	$1,222.67
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $108.04 / $230.83 / $326.43	Professional	26	$108.04	$230.83	$326.43
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $177.91 / $633.74 / $896.23	Professional	TC	$177.91	$633.74	$896.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $539.53 / $948.08 / $1,420.11	Professional		$539.53	$948.08	$1,420.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $137.94 / $225.43 / $331.68	Professional	26	$137.94	$225.43	$331.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $398.48 / $715.81 / $1,123.95	Professional	TC	$398.48	$715.81	$1,123.95
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $463.25 / $823.29 / $1,525.99	Professional		$463.25	$823.29	$1,525.99
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $123.68 / $219.80 / $407.41	Professional	26	$123.68	$219.80	$407.41
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $339.57 / $603.48 / $1,118.58	Professional	TC	$339.57	$603.48	$1,118.58
United Facility/Professional Professional Modifier Low / Median / High Price $471.17 / $617.97 / $1,036.78	Professional		$471.17	$617.97	$1,036.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $110.52 / $158.74 / $320.66	Professional	26	$110.52	$158.74	$320.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $412.38 / $481.11 / $727.66	Professional	TC	$412.38	$481.11	$727.66
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $236.98 / $326.08 / $564.66	Professional		$236.98	$326.08	$564.66
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $90.71 / $110.23 / $146.03	Professional	26	$90.71	$110.23	$146.03
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $146.28 / $181.39 / $454.45	Professional	TC	$146.28	$181.39	$454.45