Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.45 / $224.01 / $224.01	Facility	26	$58.45	$224.01	$224.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.76 / $162.22 / $500.31	Professional		$140.76	$162.22	$500.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.95 / $51.54 / $151.81	Professional	26	$43.95	$51.54	$151.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.81 / $110.68 / $348.47	Professional	TC	$96.81	$110.68	$348.47
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $170.47 / $250.27 / $362.89	Professional		$170.47	$250.27	$362.89
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $78.83 / $114.30	Professional	26	$53.70	$78.83	$114.30
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $116.77 / $171.44 / $248.58	Professional	TC	$116.77	$171.44	$248.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $226.90 / $403.39 / $534.66	Professional		$226.90	$403.39	$534.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.16 / $125.61 / $164.98	Professional	26	$70.16	$125.61	$164.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $156.72 / $277.77 / $369.69	Professional	TC	$156.72	$277.77	$369.69
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $198.49 / $346.82 / $1,205.61	Professional		$198.49	$346.82	$1,205.61
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $62.40 / $109.01 / $202.49	Professional	26	$62.40	$109.01	$202.49
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $135.69 / $237.07 / $440.36	Professional	TC	$135.69	$237.07	$440.36
United Facility/Professional Professional Modifier Low / Median / High Price $225.89 / $259.12 / $475.25	Professional		$225.89	$259.12	$475.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.47 / $73.03 / $111.20	Professional	26	$55.47	$73.03	$111.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $127.38 / $158.19 / $246.19	Professional	TC	$127.38	$158.19	$246.19
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $143.24 / $171.89 / $252.68	Professional		$143.24	$171.89	$252.68
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $45.21 / $54.25 / $72.79	Professional	26	$45.21	$54.25	$72.79
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $98.03 / $116.66 / $163.60	Professional	TC	$98.03	$116.66	$163.60