Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.40 / $62.46 / $162.00	Facility	26	$59.40	$62.46	$162.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.83 / $151.91 / $228.27	Professional		$113.83	$151.91	$228.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.00 / $59.41 / $120.08	Professional	26	$53.00	$59.41	$120.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.39 / $89.90 / $115.66	Professional	TC	$57.39	$89.90	$115.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $98.13 / $98.13 / $98.13	Professional		$98.13	$98.13	$98.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.15 / $83.07 / $103.68	Professional	26	$48.15	$83.07	$103.68
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $64.06 / $200.48 / $560.25	Professional		$64.06	$200.48	$560.25
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $52.49 / $99.47 / $144.44	Professional	26	$52.49	$99.47	$144.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.38 / $193.00 / $331.87	Professional		$111.38	$193.00	$331.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.37 / $76.73 / $132.88	Professional	26	$51.37	$76.73	$132.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.00 / $115.65 / $208.71	Professional	TC	$60.00	$115.65	$208.71
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $147.38 / $174.76 / $174.76	Professional		$147.38	$174.76	$174.76
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.40 / $81.00 / $81.00	Professional	26	$69.40	$81.00	$81.00
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.98 / $93.78 / $93.78	Professional	TC	$77.98	$93.78	$93.78
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.44 / $124.28 / $210.80	Professional		$87.44	$124.28	$210.80
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.19 / $59.39 / $100.86	Professional	26	$49.19	$59.39	$100.86
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $56.45 / $69.79 / $120.33	Professional	TC	$56.45	$69.79	$120.33
United Facility/Professional Professional Modifier Low / Median / High Price $101.73 / $156.34 / $264.33	Professional		$101.73	$156.34	$264.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.88 / $69.37 / $122.06	Professional	26	$45.88	$69.37	$122.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.12 / $88.54 / $154.63	Professional	TC	$55.12	$88.54	$154.63