Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.66 / $101.24 / $101.24	Facility	26	$45.66	$101.24	$101.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.03 / $75.81 / $132.21	Professional		$67.03	$75.81	$132.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.51 / $26.28 / $35.46	Professional	26	$23.51	$26.28	$35.46
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $33.52 / $37.90 / $39.38	Professional	52	$33.52	$37.90	$39.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.53 / $43.74 / $49.53	Professional	TC	$43.53	$43.74	$49.53
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $65.98 / $96.88 / $135.83	Professional		$65.98	$96.88	$135.83
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 $98.98 / $145.32 / $203.75	Professional	50	$98.98	$145.32	$203.75
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $36.88 / $54.14 / $75.90	Professional	TC	$36.88	$54.14	$75.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.81 / $131.74 / $207.78	Professional		$87.81	$131.74	$207.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.27 / $55.55 / $89.60	Professional	26	$36.27	$55.55	$89.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.51 / $78.04 / $118.18	Professional	TC	$49.51	$78.04	$118.18
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $74.23 / $125.77 / $248.84	Professional		$74.23	$125.77	$248.84
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $33.33 / $59.23 / $109.79	Professional	26	$33.33	$59.23	$109.79
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $42.21 / $69.58 / $130.28	Professional	TC	$42.21	$69.58	$130.28
United Facility/Professional Professional Modifier Low / Median / High Price $75.43 / $90.79 / $160.65	Professional		$75.43	$90.79	$160.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.56 / $38.72 / $70.00	Professional	26	$28.56	$38.72	$70.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.76 / $54.51 / $121.69	Professional	TC	$44.76	$54.51	$121.69
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $53.07 / $65.81 / $93.62	Professional		$53.07	$65.81	$93.62
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $23.95 / $28.18 / $38.85	Professional	26	$23.95	$28.18	$38.85
Well Sense Facility/Professional Professional Modifier 52 Low / Median / High Price $17.02 / $17.02 / $22.98	Professional	52	$17.02	$17.02	$22.98
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $28.94 / $35.89 / $53.93	Professional	TC	$28.94	$35.89	$53.93