Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $66.07 / $309.03	Facility	26	$45.71	$66.07	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $251.19 / $870.96	Professional		$131.83	$251.19	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $60.26 / $194.98	Professional	26	$38.02	$60.26	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $154.88 / $380.19	Professional	TC	$89.13	$154.88	$380.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $112.20 / $125.89	Professional		$89.13	$112.20	$125.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $38.02 / $69.18	Professional	26	$30.20	$38.02	$69.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $75.86 / $114.82	Professional	TC	$40.74	$75.86	$114.82
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $144.54 / $602.56	Professional		$43.65	$144.54	$602.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.15 / $37.15 / $37.15	Facility	26	$37.15	$37.15	$37.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $239.88 / $436.52	Professional		$109.65	$239.88	$436.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $60.26 / $102.33	Professional	26	$30.20	$60.26	$102.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $173.78 / $331.13	Professional	TC	$75.86	$173.78	$331.13
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $181.97 / $549.54	Professional		$154.88	$181.97	$549.54
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $53.70 / $549.54	Professional	26	$46.77	$53.70	$549.54
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $128.82 / $549.54	Professional	TC	$107.15	$128.82	$549.54
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $141.25 / $309.03	Professional		$120.23	$141.25	$309.03
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $41.69 / $87.10	Professional	26	$35.48	$41.69	$87.10
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $100.00 / $218.78	Professional	TC	$85.11	$100.00	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $190.55 / $323.59	Professional		$107.15	$190.55	$323.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $50.12 / $87.10	Professional	26	$32.36	$50.12	$87.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $131.83 / $245.47	Professional	TC	$75.86	$131.83	$245.47