Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $114.82 / $251.19	Facility	26	$38.90	$114.82	$251.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $147.91 / $416.87	Professional		$102.33	$147.91	$416.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $50.12 / $117.49	Professional	26	$30.90	$50.12	$117.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $102.33 / $223.87	Professional	TC	$75.86	$102.33	$223.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $128.82 / $213.80	Professional		$107.15	$128.82	$213.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $45.71 / $77.62	Professional	26	$32.36	$45.71	$77.62
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $165.96 / $275.42	Professional		$74.13	$165.96	$275.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $22.91 / $22.91	Facility	26	$22.91	$22.91	$22.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $147.91 / $269.15	Professional		$100.00	$147.91	$269.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $45.71 / $85.11	Professional	26	$30.20	$45.71	$85.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $107.15 / $194.98	Professional	TC	$66.07	$107.15	$194.98
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $190.55 / $363.08	Professional		$162.18	$190.55	$363.08
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $56.23 / $363.08	Professional	26	$48.98	$56.23	$363.08
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $134.90 / $363.08	Professional	TC	$112.20	$134.90	$363.08
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $141.25 / $269.15	Professional		$120.23	$141.25	$269.15
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $43.65 / $74.13	Professional	26	$37.15	$43.65	$74.13
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $97.72 / $204.17	Professional	TC	$83.18	$97.72	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $138.04 / $245.47	Professional		$89.13	$138.04	$245.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $43.65 / $72.44	Professional	26	$26.92	$43.65	$72.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $95.50 / $181.97	Professional	TC	$63.10	$95.50	$181.97