Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $74.13 / $346.74	Facility	26	$47.86	$74.13	$346.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $208.93 / $575.44	Professional		$89.13	$208.93	$575.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $83.18 / $229.09	Professional	26	$51.29	$83.18	$229.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $186.21 / $398.11	Professional	TC	$112.20	$186.21	$398.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $147.91 / $194.98	Professional		$147.91	$147.91	$194.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $48.98 / $102.33	Professional	26	$40.74	$48.98	$102.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $102.33 / $144.54	Professional	TC	$102.33	$102.33	$144.54
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $97.72 / $97.72	Professional		$97.72	$97.72	$97.72
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $38.02 / $38.02	Facility	26	$38.02	$38.02	$38.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $302.00 / $501.19	Professional		$151.36	$302.00	$501.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $70.79 / $123.03	Professional	26	$39.81	$70.79	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $229.09 / $380.19	Professional	TC	$114.82	$229.09	$380.19
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $234.42 / $323.59	Professional		$199.53	$234.42	$323.59
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $72.44 / $100.00	Professional	26	$63.10	$72.44	$100.00
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $162.18 / $223.87	Professional	TC	$134.90	$162.18	$223.87
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $199.53 / $416.87	Professional		$162.18	$199.53	$416.87
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $56.23 / $100.00	Professional	26	$46.77	$56.23	$100.00
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $141.25 / $309.03	Professional	TC	$120.23	$141.25	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $251.19 / $426.58	Professional		$141.25	$251.19	$426.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $63.10 / $109.65	Professional	26	$42.66	$63.10	$109.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $181.97 / $323.59	Professional	TC	$95.50	$181.97	$323.59