Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.28 / $49.29 / $249.45	Facility	26	$49.28	$49.29	$249.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $164.38 / $247.53 / $450.50	Professional		$164.38	$247.53	$450.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.29 / $59.29 / $100.80	Professional	26	$49.29	$59.29	$100.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $108.96 / $186.91 / $310.18	Professional	TC	$108.96	$186.91	$310.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.77 / $44.17 / $118.60	Professional	26	$38.77	$44.17	$118.60
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $87.00 / $87.00 / $87.00	Professional		$87.00	$87.00	$87.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.86 / $39.86 / $39.86	Facility	26	$39.86	$39.86	$39.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.87 / $331.35 / $573.34	Professional		$154.87	$331.35	$573.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.00 / $70.84 / $120.96	Professional	26	$41.00	$70.84	$120.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.44 / $260.87 / $458.01	Professional	TC	$109.44	$260.87	$458.01
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $199.68 / $264.58 / $805.59	Professional		$199.68	$264.58	$805.59
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.37 / $75.43 / $773.08	Professional	26	$64.37	$75.43	$773.08
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $134.71 / $161.94 / $773.08	Professional	TC	$134.71	$161.94	$773.08
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $162.49 / $191.17 / $357.54	Professional		$162.49	$191.17	$357.54
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.65 / $57.24 / $102.37	Professional	26	$48.65	$57.24	$102.37
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $113.85 / $133.94 / $261.63	Professional	TC	$113.85	$133.94	$261.63
United Facility/Professional Professional Modifier Low / Median / High Price $161.01 / $271.02 / $435.27	Professional		$161.01	$271.02	$435.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.71 / $67.27 / $109.29	Professional	26	$46.71	$67.27	$109.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.99 / $177.60 / $319.72	Professional	TC	$104.99	$177.60	$319.72