Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $354.81 / $676.08	Facility	26	$100.00	$354.81	$676.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $213.80 / $741.31	Professional		$123.03	$213.80	$741.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $123.03 / $380.19	Professional	26	$89.13	$123.03	$380.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $63.10 / $173.78	Professional	TC	$23.44	$63.10	$173.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $117.49 / $194.98	Professional		$107.15	$117.49	$194.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $100.00 / $154.88	Professional	26	$81.28	$100.00	$154.88
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $831.76 / $831.76	Professional		$831.76	$831.76	$831.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $239.88 / $549.54	Professional		$120.23	$239.88	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $131.83 / $234.42	Professional	26	$91.20	$131.83	$234.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $75.86 / $416.87	Professional	TC	$27.54	$75.86	$416.87
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $194.98 / $199.53	Professional		$169.82	$194.98	$199.53
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $141.25 / $144.54	Professional	26	$125.89	$141.25	$144.54
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $53.70 / $56.23	Professional	TC	$46.77	$53.70	$56.23
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $151.36 / $371.54	Professional		$112.20	$151.36	$371.54
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $120.23 / $208.93	Professional	26	$89.13	$120.23	$208.93
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $30.90 / $120.23	Professional	TC	$22.91	$30.90	$120.23
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $186.21 / $478.63	Professional		$109.65	$186.21	$478.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $117.49 / $218.78	Professional	26	$79.43	$117.49	$218.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $41.69 / $346.74	Professional	TC	$24.55	$41.69	$346.74