Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.24 / $53.61 / $214.23	Facility	26	$41.24	$53.61	$214.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $125.17 / $155.12 / $255.34	Professional		$125.17	$155.12	$255.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.42 / $52.24 / $79.70	Professional	26	$42.42	$52.24	$79.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.93 / $103.06 / $152.69	Professional	TC	$83.93	$103.06	$152.69
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $96.07 / $120.69 / $139.83	Professional		$96.07	$120.69	$139.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.79 / $47.77 / $93.84	Professional	26	$37.79	$47.77	$93.84
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $116.09 / $116.09 / $116.09	Professional	TC	$116.09	$116.09	$116.09
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $137.91 / $261.00 / $330.27	Professional		$137.91	$261.00	$330.27
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $45.44 / $79.67 / $305.60	Professional	26	$45.44	$79.67	$305.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.20 / $190.77 / $314.94	Professional		$107.20	$190.77	$314.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.60 / $63.96 / $107.32	Professional	26	$36.60	$63.96	$107.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.59 / $120.10 / $208.51	Professional	TC	$70.59	$120.10	$208.51
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $162.99 / $193.44 / $373.82	Professional		$162.99	$193.44	$373.82
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.32 / $67.03 / $91.46	Professional	26	$57.32	$67.03	$91.46
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $105.19 / $126.41 / $171.77	Professional	TC	$105.19	$126.41	$171.77
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $124.01 / $145.88 / $218.23	Professional		$124.01	$145.88	$218.23
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.62 / $48.96 / $92.03	Professional	26	$41.62	$48.96	$92.03
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $82.39 / $96.93 / $154.16	Professional	TC	$82.39	$96.93	$154.16
United Facility/Professional Professional Modifier Low / Median / High Price $123.32 / $174.06 / $293.88	Professional		$123.32	$174.06	$293.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.41 / $59.95 / $95.33	Professional	26	$41.41	$59.95	$95.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.59 / $114.88 / $199.75	Professional	TC	$80.59	$114.88	$199.75