Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $165.96 / $380.19	Facility	26	$51.29	$165.96	$380.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $288.40 / $977.24	Professional		$169.82	$288.40	$977.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $83.18 / $194.98	Professional	26	$53.70	$83.18	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $177.83 / $389.05	Professional	TC	$114.82	$177.83	$389.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $123.03 / $169.82	Professional		$114.82	$123.03	$169.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $50.12 / $89.13	Professional	26	$44.67	$50.12	$89.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $120.23 / $120.23	Professional	TC	$120.23	$120.23	$120.23
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $173.78 / $269.15	Professional		$107.15	$173.78	$269.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $41.69 / $41.69	Facility	26	$41.69	$41.69	$41.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $316.23 / $512.86	Professional		$144.54	$316.23	$512.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $77.62 / $134.90	Professional	26	$43.65	$77.62	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $218.78 / $407.38	Professional	TC	$97.72	$218.78	$407.38
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $245.47 / $776.25	Professional		$204.17	$245.47	$776.25
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $79.43 / $776.25	Professional	26	$69.18	$79.43	$776.25
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $165.96 / $776.25	Professional	TC	$138.04	$165.96	$776.25
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $190.55 / $380.19	Professional		$114.82	$190.55	$380.19
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $61.66 / $100.00	Professional	26	$51.29	$61.66	$100.00
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $134.90 / $331.13	Professional	TC	$117.49	$134.90	$331.13
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $257.04 / $436.52	Professional		$144.54	$257.04	$436.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $69.18 / $120.23	Professional	26	$46.77	$69.18	$120.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $169.82 / $309.03	Professional	TC	$97.72	$169.82	$309.03