Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.54 / $93.16 / $355.54	Facility	26	$66.54	$93.16	$355.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $175.51 / $215.12 / $481.17	Professional		$175.51	$215.12	$481.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.55 / $86.40 / $244.30	Professional	26	$66.55	$86.40	$244.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.08 / $125.67 / $215.93	Professional	TC	$99.08	$125.67	$215.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $86.97 / $149.07 / $185.14	Professional		$86.97	$149.07	$185.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $60.51 / $72.17 / $135.66	Professional	26	$60.51	$72.17	$135.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $92.59 / $92.59 / $92.59	Professional	TC	$92.59	$92.59	$92.59
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $145.16 / $296.00 / $717.36	Professional		$145.16	$296.00	$717.36
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $86.44 / $170.17 / $256.42	Professional	26	$86.44	$170.17	$256.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $149.38 / $254.64 / $458.41	Professional		$149.38	$254.64	$458.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.72 / $104.10 / $174.35	Professional	26	$59.72	$104.10	$174.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.95 / $153.69 / $272.83	Professional	TC	$85.95	$153.69	$272.83
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $216.84 / $279.08 / $483.08	Professional		$216.84	$279.08	$483.08
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $92.39 / $108.05 / $147.41	Professional	26	$92.39	$108.05	$147.41
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $123.68 / $148.69 / $201.86	Professional	TC	$123.68	$148.69	$201.86
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $164.87 / $193.96 / $306.75	Professional		$164.87	$193.96	$306.75
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.45 / $81.70 / $129.94	Professional	26	$69.45	$81.70	$129.94
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.42 / $112.26 / $178.54	Professional	TC	$95.42	$112.26	$178.54
United Facility/Professional Professional Modifier Low / Median / High Price $163.66 / $229.67 / $392.02	Professional		$163.66	$229.67	$392.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.42 / $98.06 / $164.40	Professional	26	$68.42	$98.06	$164.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.15 / $136.85 / $230.88	Professional	TC	$93.15	$136.85	$230.88