Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.78 / $97.69 / $674.22	Facility	26	$69.78	$97.69	$674.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $288.06 / $341.59 / $612.25	Professional		$288.06	$341.59	$612.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.86 / $91.00 / $273.52	Professional	26	$72.86	$91.00	$273.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $213.32 / $250.16 / $405.06	Professional	TC	$213.32	$250.16	$405.06
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $142.06 / $241.25 / $290.27	Professional		$142.06	$241.25	$290.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.64 / $77.34 / $159.25	Professional	26	$63.64	$77.34	$159.25
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $195.17 / $195.17 / $195.17	Professional	TC	$195.17	$195.17	$195.17
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $93.35 / $344.25 / $600.00	Professional		$93.35	$344.25	$600.00
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $95.55 / $179.00 / $267.87	Professional	26	$95.55	$179.00	$267.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $242.45 / $417.19 / $717.84	Professional		$242.45	$417.19	$717.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.69 / $109.63 / $183.31	Professional	26	$62.69	$109.63	$183.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.12 / $309.51 / $513.07	Professional	TC	$181.12	$309.51	$513.07
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $358.46 / $444.21 / $768.62	Professional		$358.46	$444.21	$768.62
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.60 / $113.75 / $155.93	Professional	26	$97.60	$113.75	$155.93
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $260.24 / $313.13 / $424.10	Professional	TC	$260.24	$313.13	$424.10
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $272.75 / $320.88 / $510.35	Professional		$272.75	$320.88	$510.35
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.84 / $85.71 / $136.32	Professional	26	$72.84	$85.71	$136.32
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $199.90 / $235.18 / $374.04	Professional	TC	$199.90	$235.18	$374.04
United Facility/Professional Professional Modifier Low / Median / High Price $254.32 / $368.83 / $631.54	Professional		$254.32	$368.83	$631.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.94 / $102.82 / $170.99	Professional	26	$69.94	$102.82	$170.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $175.34 / $246.26 / $460.80	Professional	TC	$175.34	$246.26	$460.80