Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.39 / $31.40 / $98.08	Facility	26	$31.39	$31.40	$98.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $227.57 / $282.77 / $417.56	Professional		$227.57	$282.77	$417.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.73 / $35.15 / $48.44	Professional	26	$25.73	$35.15	$48.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $201.65 / $247.61 / $358.96	Professional	TC	$201.65	$247.61	$358.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $218.46 / $218.46 / $218.46	Professional		$218.46	$218.46	$218.46
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.19 / $30.99 / $48.79	Professional	26	$27.19	$30.99	$48.79
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $66.48 / $66.48 / $102.00	Professional		$66.48	$66.48	$102.00
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $43.63 / $80.62 / $109.57	Professional	26	$43.63	$80.62	$109.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $207.68 / $346.42 / $609.66	Professional		$207.68	$346.42	$609.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.26 / $45.40 / $76.53	Professional	26	$26.26	$45.40	$76.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $177.00 / $300.22 / $539.42	Professional	TC	$177.00	$300.22	$539.42
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $416.84 / $416.84 / $416.84	Professional		$416.84	$416.84	$416.84
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.45 / $48.45 / $48.45	Professional	26	$48.45	$48.45	$48.45
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $368.39 / $368.39 / $368.39	Professional	TC	$368.39	$368.39	$368.39
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $285.07 / $335.38 / $438.71	Professional		$285.07	$335.38	$438.71
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.93 / $36.39 / $54.86	Professional	26	$30.93	$36.39	$54.86
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $254.13 / $298.98 / $323.02	Professional	TC	$254.13	$298.98	$323.02
United Facility/Professional Professional Modifier Low / Median / High Price $221.01 / $377.93 / $682.87	Professional		$221.01	$377.93	$682.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.79 / $44.34 / $73.66	Professional	26	$31.79	$44.34	$73.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $235.34 / $341.01 / $610.45	Professional	TC	$235.34	$341.01	$610.45