Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $100.00 / $251.19	Facility	26	$63.10	$100.00	$251.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $144.54 / $257.04	Professional		$89.13	$144.54	$257.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $58.88 / $147.91	Professional	26	$41.69	$58.88	$147.91
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $44.67 / $87.10 / $245.47	Professional	52	$44.67	$87.10	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $77.62 / $169.82	Professional	TC	$45.71	$77.62	$169.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $100.00 / $109.65	Professional		$77.62	$100.00	$109.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $51.29 / $74.13	Professional	26	$18.62	$51.29	$74.13
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $25.12 / $25.12 / $25.12	Professional	52	$25.12	$25.12	$25.12
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $162.18 / $245.47	Professional		$102.33	$162.18	$245.47
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $67.61 / $109.65	Professional	26	$44.67	$67.61	$109.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $83.18 / $138.04	Professional	TC	$58.88	$83.18	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $204.17 / $389.05	Professional		$112.20	$204.17	$389.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $91.20 / $162.18	Professional	26	$50.12	$91.20	$162.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $117.49 / $234.42	Professional	TC	$63.10	$117.49	$234.42
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $165.96 / $275.42	Professional		$112.20	$165.96	$275.42
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $74.13 / $120.23	Professional	26	$48.98	$74.13	$120.23
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $104.71 / $158.49	Professional	TC	$64.57	$104.71	$158.49
United Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $194.98 / $398.11	Professional		$120.23	$194.98	$398.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $75.86 / $151.36	Professional	26	$48.98	$75.86	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $117.49 / $229.09	Professional	TC	$69.18	$117.49	$229.09
Well Sense Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $27.54 / $32.36	Facility	26	$27.54	$27.54	$32.36