Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $64.57 / $295.12	Facility	26	$48.98	$64.57	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $223.87 / $588.84	Professional		$117.49	$223.87	$588.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $79.43 / $194.98	Professional	26	$39.81	$79.43	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $104.71 / $251.19	Professional	TC	$72.44	$104.71	$251.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $117.49 / $186.21	Professional		$91.20	$117.49	$186.21
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $46.77 / $79.43	Professional	26	$38.02	$46.77	$79.43
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $79.43 / $117.49	Professional	TC	$60.26	$79.43	$117.49
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $158.49 / $234.42	Professional		$64.57	$158.49	$234.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $181.97 / $316.23	Professional		$114.82	$181.97	$316.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $61.66 / $100.00	Professional	26	$37.15	$61.66	$100.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $114.82 / $199.53	Professional	TC	$70.79	$114.82	$199.53
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $165.96 / $229.09	Professional		$158.49	$165.96	$229.09
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $56.23 / $77.62	Professional	26	$52.48	$56.23	$77.62
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $112.20 / $154.88	Professional	TC	$107.15	$112.20	$154.88
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $141.25 / $275.42	Professional		$117.49	$141.25	$275.42
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $47.86 / $102.33	Professional	26	$40.74	$47.86	$102.33
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $95.50 / $199.53	Professional	TC	$81.28	$95.50	$199.53
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $147.91 / $263.03	Professional		$104.71	$147.91	$263.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $51.29 / $89.13	Professional	26	$35.48	$51.29	$89.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $95.50 / $173.78	Professional	TC	$69.18	$95.50	$173.78