Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.75 / $79.44 / $285.25	Facility	26	$56.75	$79.44	$285.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $221.98 / $357.05 / $637.00	Professional		$221.98	$357.05	$637.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.75 / $69.31 / $147.63	Professional	26	$56.75	$69.31	$147.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $159.22 / $244.37 / $471.30	Professional	TC	$159.22	$244.37	$471.30
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $115.25 / $195.19 / $266.89	Professional		$115.25	$195.19	$266.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.67 / $62.38 / $121.64	Professional	26	$50.67	$62.38	$121.64
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $104.00 / $290.25 / $600.00	Professional		$104.00	$290.25	$600.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.85 / $45.85 / $45.85	Facility	26	$45.85	$45.85	$45.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.86 / $418.39 / $733.39	Professional		$218.86	$418.39	$733.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.34 / $82.66 / $139.47	Professional	26	$47.34	$82.66	$139.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $164.54 / $325.04 / $613.97	Professional	TC	$164.54	$325.04	$613.97
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $291.05 / $386.28 / $1,077.24	Professional		$291.05	$386.28	$1,077.24
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $73.81 / $86.43 / $921.62	Professional	26	$73.81	$86.43	$921.62
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $216.56 / $260.51 / $921.62	Professional	TC	$216.56	$260.51	$921.62
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $208.39 / $245.16 / $460.68	Professional		$208.39	$245.16	$460.68
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.91 / $65.78 / $112.25	Professional	26	$55.91	$65.78	$112.25
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $152.47 / $179.38 / $325.07	Professional	TC	$152.47	$179.38	$325.07
United Facility/Professional Professional Modifier Low / Median / High Price $234.16 / $354.67 / $583.52	Professional		$234.16	$354.67	$583.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.39 / $76.92 / $130.77	Professional	26	$54.39	$76.92	$130.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $157.30 / $274.92 / $450.43	Professional	TC	$157.30	$274.92	$450.43