Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $128.41 / $239.49 / $239.49	Facility		$128.41	$239.49	$239.49
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.57 / $87.57 / $87.57	Facility	26	$87.57	$87.57	$87.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.13 / $86.46 / $155.72	Professional		$46.13	$86.46	$155.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.10 / $30.24 / $39.34	Professional	26	$28.10	$30.24	$39.34
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $43.23 / $46.09 / $46.09	Professional	52	$43.23	$46.09	$46.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.00 / $58.15 / $150.78	Professional	TC	$40.00	$58.15	$150.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.61 / $60.64 / $89.80	Professional		$45.61	$60.64	$89.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.79 / $36.82 / $56.59	Professional	26	$28.79	$36.82	$56.59
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $68.41 / $90.96 / $134.49	Professional	50	$68.41	$90.96	$134.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.82 / $23.62 / $33.06	Professional	TC	$16.82	$23.62	$33.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.42 / $95.68 / $173.05	Professional		$48.42	$95.68	$173.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.35 / $47.96 / $81.00	Professional	26	$30.35	$47.96	$81.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.07 / $38.67 / $89.10	Professional	TC	$18.07	$38.67	$89.10
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $40.10 / $82.46 / $171.98	Professional		$40.10	$82.46	$171.98
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $32.96 / $54.88 / $101.73	Professional	26	$32.96	$54.88	$101.73
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $19.26 / $31.68 / $59.45	Professional	TC	$19.26	$31.68	$59.45
United Facility/Professional Professional Modifier Low / Median / High Price $60.67 / $104.53 / $162.13	Professional		$60.67	$104.53	$162.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.25 / $43.46 / $75.88	Professional	26	$32.25	$43.46	$75.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.08 / $51.27 / $92.63	Professional	TC	$33.08	$51.27	$92.63
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $54.56 / $66.95 / $93.94	Professional		$54.56	$66.95	$93.94
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $23.95 / $28.18 / $38.46	Professional	26	$23.95	$28.18	$38.46
Well Sense Facility/Professional Professional Modifier 52 Low / Median / High Price $17.85 / $21.42 / $24.10	Professional	52	$17.85	$21.42	$24.10
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $25.46 / $31.57 / $50.21	Professional	TC	$25.46	$31.57	$50.21