Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $608.72 / $608.72 / $608.72	Facility	26	$608.72	$608.72	$608.72
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $566.54 / $566.54 / $566.54	Facility	53	$566.54	$566.54	$566.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $781.70 / $964.02 / $2,653.78	Professional		$781.70	$964.02	$2,653.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $162.72 / $200.31 / $520.77	Professional	26	$162.72	$200.31	$520.77
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $390.85 / $463.56 / $549.72	Professional	52	$390.85	$463.56	$549.72
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $156.34 / $185.42 / $219.89	Professional	53	$156.34	$185.42	$219.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $657.97 / $763.71 / $2,132.98	Professional	TC	$657.97	$763.71	$2,132.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $353.90 / $353.90 / $353.90	Professional	26	$353.90	$353.90	$353.90
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $675.72 / $1,149.01 / $1,671.19	Professional		$675.72	$1,149.01	$1,671.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $106.74 / $178.35 / $264.00	Professional	26	$106.74	$178.35	$264.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $568.97 / $962.87 / $1,407.20	Professional	TC	$568.97	$962.87	$1,407.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $797.32 / $1,441.47 / $2,151.64	Professional		$797.32	$1,441.47	$2,151.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $123.33 / $226.61 / $372.38	Professional	26	$123.33	$226.61	$372.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $673.99 / $1,223.19 / $1,729.69	Professional	TC	$673.99	$1,223.19	$1,729.69
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $806.13 / $1,477.42 / $2,548.17	Professional		$806.13	$1,477.42	$2,548.17
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $122.20 / $211.38 / $402.54	Professional	26	$122.20	$211.38	$402.54
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $651.36 / $1,126.72 / $2,145.64	Professional	TC	$651.36	$1,126.72	$2,145.64
United Facility/Professional Professional Modifier Low / Median / High Price $1,105.03 / $1,751.72 / $2,989.10	Professional		$1,105.03	$1,751.72	$2,989.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $132.09 / $223.26 / $434.32	Professional	26	$132.09	$223.26	$434.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $747.41 / $1,203.23 / $2,530.44	Professional	TC	$747.41	$1,203.23	$2,530.44
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $712.69 / $855.23 / $1,234.39	Professional		$712.69	$855.23	$1,234.39
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $99.56 / $139.38 / $218.84	Professional	26	$99.56	$139.38	$218.84
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $595.88 / $714.24 / $1,028.14	Professional	TC	$595.88	$714.24	$1,028.14