Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.59 / $51.59 / $259.49	Facility	26	$51.59	$51.59	$259.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.42 / $281.67 / $571.00	Professional		$169.42	$281.67	$571.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.59 / $63.06 / $126.75	Professional	26	$51.59	$63.06	$126.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $111.43 / $185.11 / $313.58	Professional	TC	$111.43	$185.11	$313.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $120.96 / $131.50 / $151.38	Professional		$120.96	$131.50	$151.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.73 / $52.74 / $56.95	Professional	26	$44.73	$52.74	$56.95
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.94 / $102.94 / $102.94	Professional	TC	$102.94	$102.94	$102.94
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $107.84 / $148.28 / $271.00	Professional		$107.84	$148.28	$271.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.83 / $41.83 / $41.83	Facility	26	$41.83	$41.83	$41.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $145.66 / $319.30 / $544.29	Professional		$145.66	$319.30	$544.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.99 / $75.45 / $127.38	Professional	26	$42.99	$75.45	$127.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.31 / $225.63 / $422.37	Professional	TC	$97.31	$225.63	$422.37
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $205.54 / $272.48 / $808.46	Professional		$205.54	$272.48	$808.46
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.53 / $78.94 / $779.83	Professional	26	$67.53	$78.94	$779.83
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $137.46 / $165.28 / $779.83	Professional	TC	$137.46	$165.28	$779.83
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $158.74 / $186.75 / $396.97	Professional		$158.74	$186.75	$396.97
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.63 / $59.56 / $88.28	Professional	26	$50.63	$59.56	$88.28
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $108.11 / $127.19 / $204.71	Professional	TC	$108.11	$127.19	$204.71
United Facility/Professional Professional Modifier Low / Median / High Price $155.68 / $258.24 / $421.15	Professional		$155.68	$258.24	$421.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.36 / $71.45 / $119.00	Professional	26	$47.36	$71.45	$119.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $105.36 / $171.50 / $302.61	Professional	TC	$105.36	$171.50	$302.61