Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $154.88 / $354.81	Facility	26	$58.88	$154.88	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $223.87 / $812.83	Professional		$138.04	$223.87	$812.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $79.43 / $186.21	Professional	26	$51.29	$79.43	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $123.03 / $380.19	Professional	TC	$79.43	$123.03	$380.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $97.72 / $123.03	Professional		$91.20	$97.72	$123.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $53.70 / $107.15	Professional	26	$43.65	$53.70	$107.15
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $102.33 / $102.33	Professional	TC	$102.33	$102.33	$102.33
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $380.19 / $380.19	Professional		$380.19	$380.19	$380.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $38.90 / $38.90	Facility	26	$38.90	$38.90	$38.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $245.47 / $446.68	Professional		$114.82	$245.47	$446.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $70.79 / $125.89	Professional	26	$40.74	$70.79	$125.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $158.49 / $323.59	Professional	TC	$69.18	$158.49	$323.59
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $190.55 / $645.65	Professional		$162.18	$190.55	$645.65
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $74.13 / $645.65	Professional	26	$64.57	$74.13	$645.65
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $117.49 / $645.65	Professional	TC	$97.72	$117.49	$645.65
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $151.36 / $295.12	Professional		$123.03	$151.36	$295.12
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $57.54 / $97.72	Professional	26	$48.98	$57.54	$97.72
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $93.33 / $181.97	Professional	TC	$79.43	$93.33	$181.97
United Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $199.53 / $346.74	Professional		$114.82	$199.53	$346.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $64.57 / $112.20	Professional	26	$43.65	$64.57	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $123.03 / $229.09	Professional	TC	$69.18	$123.03	$229.09