Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $209.72 / $209.72 / $209.72	Facility		$209.72	$209.72	$209.72
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.17 / $69.17 / $69.17	Facility	26	$69.17	$69.17	$69.17
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $140.55 / $140.55 / $386.42	Facility	TC	$140.55	$140.55	$386.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.18 / $76.56 / $200.54	Professional		$47.18	$76.56	$200.54
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $71.59 / $71.59 / $71.59	Professional	25	$71.59	$71.59	$71.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.89 / $23.58 / $62.41	Professional	26	$21.89	$23.58	$62.41
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $85.42 / $85.42 / $89.26	Professional	50	$85.42	$85.42	$89.26
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $27.71 / $38.29 / $40.33	Professional	52	$27.71	$38.29	$40.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.04 / $55.64 / $138.13	Professional	TC	$31.04	$55.64	$138.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $119.20 / $119.20 / $119.20	Professional		$119.20	$119.20	$119.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.58 / $47.92 / $70.58	Professional		$35.58	$47.92	$70.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.73 / $26.57 / $38.83	Professional	26	$19.73	$26.57	$38.83
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $53.37 / $71.89 / $105.07	Professional	50	$53.37	$71.89	$105.07
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $21.35 / $31.48	Professional	TC	$15.85	$21.35	$31.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.78 / $74.70 / $151.82	Professional		$37.78	$74.70	$151.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.75 / $37.64 / $55.38	Professional	26	$20.75	$37.64	$55.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.03 / $37.07 / $83.27	Professional	TC	$17.03	$37.07	$83.27
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $34.26 / $67.00 / $134.16	Professional		$34.26	$67.00	$134.16
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $22.59 / $39.08 / $69.72	Professional	26	$22.59	$39.08	$69.72
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $18.14 / $29.90 / $59.76	Professional	TC	$18.14	$29.90	$59.76
United Facility/Professional Professional Modifier Low / Median / High Price $45.83 / $75.38 / $124.85	Professional		$45.83	$75.38	$124.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.01 / $31.49 / $52.50	Professional	26	$22.01	$31.49	$52.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.82 / $39.68 / $85.64	Professional	TC	$23.82	$39.68	$85.64
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $35.74 / $49.18 / $74.12	Professional		$35.74	$49.18	$74.12
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $16.64 / $20.54 / $27.00	Professional	26	$16.64	$20.54	$27.00
Well Sense Facility/Professional Professional Modifier 52 Low / Median / High Price $15.83 / $19.00 / $21.37	Professional	52	$15.83	$19.00	$21.37
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $19.07 / $26.25 / $51.00	Professional	TC	$19.07	$26.25	$51.00