Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $73.04 / $327.57 / $327.57	Facility		$73.04	$327.57	$327.57
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.63 / $175.98 / $175.98	Facility	26	$45.63	$175.98	$175.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.55 / $90.20 / $229.88	Professional		$72.55	$90.20	$229.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.09 / $48.42 / $134.60	Professional	26	$40.09	$48.42	$134.60
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $82.23 / $82.23 / $179.00	Professional	50	$82.23	$82.23	$179.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.46 / $36.89 / $116.14	Professional	TC	$32.46	$36.89	$116.14
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $195.30 / $245.44 / $272.64	Facility		$195.30	$245.44	$272.64
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.26 / $67.91 / $95.86	Professional		$46.26	$67.91	$95.86
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.11 / $42.74 / $59.92	Professional	26	$29.11	$42.74	$59.92
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $69.39 / $101.86 / $142.82	Professional	50	$69.39	$101.86	$142.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.14 / $25.17 / $35.29	Professional	TC	$17.14	$25.17	$35.29
Cigna Facility/Professional Facility Modifier Low / Median / High Price $82.61 / $257.22 / $640.01	Facility		$82.61	$257.22	$640.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.26 / $109.06 / $199.56	Professional		$61.26	$109.06	$199.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.27 / $65.40 / $115.36	Professional	26	$38.27	$65.40	$115.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.63 / $41.40 / $95.03	Professional	TC	$23.63	$41.40	$95.03
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $52.95 / $88.16 / $174.42	Professional		$52.95	$88.16	$174.42
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $33.33 / $57.65 / $102.87	Professional	26	$33.33	$57.65	$102.87
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $19.63 / $32.36 / $60.59	Professional	TC	$19.63	$32.36	$60.59
United Facility/Professional Professional Modifier Low / Median / High Price $60.84 / $91.71 / $197.55	Professional		$60.84	$91.71	$197.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.33 / $42.98 / $132.30	Professional	26	$35.33	$42.98	$132.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.82 / $29.41 / $91.47	Professional	TC	$23.82	$29.41	$91.47
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $45.89 / $70.41 / $113.18	Professional		$45.89	$70.41	$113.18
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $24.38 / $38.11 / $58.41	Professional	26	$24.38	$38.11	$58.41
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $17.35 / $23.87 / $43.58	Professional	TC	$17.35	$23.87	$43.58