Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $105.29 / $105.29 / $139.36	Facility		$105.29	$105.29	$139.36
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.65 / $75.64 / $173.95	Facility	26	$35.65	$75.64	$173.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.65 / $105.29 / $363.03	Professional		$54.65	$105.29	$363.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.50 / $36.47 / $143.00	Professional	26	$28.50	$36.47	$143.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $115.34 / $209.18 / $402.38	Professional	50	$115.34	$209.18	$402.38
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.00 / $52.65 / $87.44	Professional	52	$30.00	$52.65	$87.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.88 / $68.56 / $232.83	Professional	TC	$29.88	$68.56	$232.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $49.15 / $101.12 / $152.91	Professional		$49.15	$101.12	$152.91
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.73 / $43.11 / $55.70	Professional	26	$29.73	$43.11	$55.70
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $73.73 / $151.68 / $223.18	Professional	50	$73.73	$151.68	$223.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.57 / $64.84 / $100.34	Professional	TC	$18.57	$64.84	$100.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $154.30 / $201.82 / $462.43	Facility		$154.30	$201.82	$462.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.21 / $106.85 / $167.58	Professional		$62.21	$106.85	$167.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.81 / $41.22 / $87.51	Professional	26	$32.81	$41.22	$87.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.58 / $71.40 / $103.73	Professional	TC	$24.58	$71.40	$103.73
ConnectiCare Facility/Professional Professional Modifier Low / Median / High Price $54.45 / $79.25 / $127.32	Professional		$54.45	$79.25	$127.32
ConnectiCare Facility/Professional Professional Modifier 26 Low / Median / High Price $33.92 / $43.58 / $56.09	Professional	26	$33.92	$43.58	$56.09
ConnectiCare Facility/Professional Professional Modifier TC Low / Median / High Price $20.53 / $30.62 / $71.47	Professional	TC	$20.53	$30.62	$71.47
Health New England Facility/Professional Professional Modifier Low / Median / High Price $73.19 / $112.08 / $120.22	Professional		$73.19	$112.08	$120.22
United Facility/Professional Professional Modifier Low / Median / High Price $52.62 / $80.80 / $151.58	Professional		$52.62	$80.80	$151.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.48 / $35.86 / $70.75	Professional	26	$25.48	$35.86	$70.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.31 / $38.86 / $74.20	Professional	TC	$21.31	$38.86	$74.20