Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.14 / $70.20 / $253.77	Facility	26	$50.14	$70.20	$253.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.37 / $247.46 / $521.70	Professional		$123.37	$247.46	$521.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $59.62 / $181.06	Professional	26	$51.30	$59.62	$181.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $104.43 / $185.79 / $298.43	Professional	TC	$104.43	$185.79	$298.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $63.16 / $110.12 / $146.38	Professional		$63.16	$110.12	$146.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.49 / $49.21 / $79.55	Professional	26	$40.49	$49.21	$79.55
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $50.73 / $50.73 / $50.73	Professional	TC	$50.73	$50.73	$50.73
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $87.40 / $170.95 / $450.00	Professional		$87.40	$170.95	$450.00
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $63.68 / $107.82 / $184.73	Professional	26	$63.68	$107.82	$184.73
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.89 / $40.89 / $40.89	Facility	26	$40.89	$40.89	$40.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.85 / $338.10 / $562.34	Professional		$154.85	$338.10	$562.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.78 / $71.92 / $123.83	Professional	26	$39.78	$71.92	$123.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.93 / $260.87 / $429.55	Professional	TC	$114.93	$260.87	$429.55
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $197.85 / $262.31 / $808.06	Professional		$197.85	$262.31	$808.06
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.80 / $72.36 / $775.32	Professional	26	$61.80	$72.36	$775.32
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $135.49 / $162.90 / $775.32	Professional	TC	$135.49	$162.90	$775.32
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $140.04 / $170.06 / $391.55	Professional		$140.04	$170.06	$391.55
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.80 / $58.59 / $81.56	Professional	26	$49.80	$58.59	$81.56
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $113.24 / $119.03 / $322.24	Professional	TC	$113.24	$119.03	$322.24
United Facility/Professional Professional Modifier Low / Median / High Price $161.66 / $264.58 / $434.86	Professional		$161.66	$264.58	$434.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.75 / $68.45 / $115.03	Professional	26	$43.75	$68.45	$115.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $103.85 / $176.67 / $310.18	Professional	TC	$103.85	$176.67	$310.18