Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $135.00 / $135.00 / $135.00	Facility	26	$135.00	$135.00	$135.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $844.53 / $964.02 / $1,280.89	Professional		$844.53	$964.02	$1,280.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $135.00 / $187.33 / $228.77	Professional	26	$135.00	$187.33	$228.77
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $390.85 / $453.13 / $482.01	Professional	52	$390.85	$453.13	$482.01
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $156.34 / $181.25 / $192.80	Professional	53	$156.34	$181.25	$192.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $722.96 / $771.25 / $1,018.78	Professional	TC	$722.96	$771.25	$1,018.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $781.83 / $968.42 / $1,392.53	Professional		$781.83	$968.42	$1,392.53
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $106.74 / $144.84 / $209.83	Professional	26	$106.74	$144.84	$209.83
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $664.02 / $830.54 / $1,182.70	Professional	TC	$664.02	$830.54	$1,182.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $926.50 / $1,278.88 / $1,775.49	Professional		$926.50	$1,278.88	$1,775.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $134.31 / $212.62 / $308.32	Professional	26	$134.31	$212.62	$308.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $752.75 / $1,094.44 / $1,524.05	Professional	TC	$752.75	$1,094.44	$1,524.05
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $861.09 / $1,036.19 / $1,869.25	Professional		$861.09	$1,036.19	$1,869.25
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $136.03 / $163.69 / $295.29	Professional	26	$136.03	$163.69	$295.29
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $725.06 / $872.51 / $1,573.96	Professional	TC	$725.06	$872.51	$1,573.96
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $843.40 / $927.12 / $1,280.89	Professional		$843.40	$927.12	$1,280.89
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $135.00 / $172.54 / $228.77	Professional	26	$135.00	$172.54	$228.77
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $390.85 / $453.13 / $482.01	Professional	52	$390.85	$453.13	$482.01
Martin's Point Facility/Professional Professional Modifier 53 Low / Median / High Price $156.34 / $181.25 / $192.80	Professional	53	$156.34	$181.25	$192.80
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $716.88 / $771.25 / $1,108.33	Professional	TC	$716.88	$771.25	$1,108.33
United Facility/Professional Professional Modifier Low / Median / High Price $879.50 / $1,446.27 / $1,625.01	Professional		$879.50	$1,446.27	$1,625.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $132.09 / $261.23 / $326.52	Professional	26	$132.09	$261.23	$326.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $728.13 / $986.87 / $1,573.96	Professional	TC	$728.13	$986.87	$1,573.96