Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $98.63 / $330.67 / $330.67	Facility		$98.63	$330.67	$330.67
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.45 / $54.79 / $54.79	Facility	26	$26.45	$54.79	$54.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $62.21 / $115.71 / $139.88	Professional		$62.21	$115.71	$139.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.90 / $17.64 / $25.87	Professional	26	$15.90	$17.64	$25.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.92 / $99.80 / $121.91	Professional	TC	$44.92	$99.80	$121.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.05 / $93.28 / $151.22	Professional		$64.05	$93.28	$151.22
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.47 / $25.44 / $38.50	Professional	26	$17.47	$25.44	$38.50
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $46.58 / $67.84 / $108.28	Professional	TC	$46.58	$67.84	$108.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.76 / $129.13 / $240.04	Professional		$77.76	$129.13	$240.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.85 / $30.96 / $53.59	Professional	26	$20.85	$30.96	$53.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.91 / $103.96 / $188.16	Professional	TC	$56.91	$103.96	$188.16
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $73.31 / $120.87 / $226.30	Professional		$73.31	$120.87	$226.30
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $20.00 / $32.90 / $61.73	Professional	26	$20.00	$32.90	$61.73
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $53.32 / $87.90 / $164.57	Professional	TC	$53.32	$87.90	$164.57
United Facility/Professional Professional Modifier Low / Median / High Price $77.50 / $112.21 / $227.87	Professional		$77.50	$112.21	$227.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.66 / $31.37 / $63.49	Professional	26	$20.66	$31.37	$63.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.81 / $101.47 / $166.25	Professional	TC	$59.81	$101.47	$166.25
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $58.89 / $74.95 / $125.83	Professional		$58.89	$74.95	$125.83
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $14.46 / $17.35 / $22.75	Professional	26	$14.46	$17.35	$22.75
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $39.08 / $48.85 / $107.93	Professional	TC	$39.08	$48.85	$107.93