Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.82 / $34.82 / $105.02	Facility	26	$34.82	$34.82	$105.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $201.33 / $257.33 / $353.86	Professional		$201.33	$257.33	$353.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.78 / $38.74 / $57.02	Professional	26	$27.78	$38.74	$57.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $173.55 / $218.37 / $267.50	Professional	TC	$173.55	$218.37	$267.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $195.08 / $195.08 / $195.08	Professional		$195.08	$195.08	$195.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.83 / $35.11 / $48.26	Professional	26	$30.83	$35.11	$48.26
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $42.40 / $71.92 / $113.90	Professional		$42.40	$71.92	$113.90
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $47.20 / $87.21 / $117.48	Professional	26	$47.20	$87.21	$117.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $206.58 / $301.89 / $502.41	Professional		$206.58	$301.89	$502.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.24 / $49.92 / $84.68	Professional	26	$28.24	$49.92	$84.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $166.27 / $252.44 / $424.73	Professional	TC	$166.27	$252.44	$424.73
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $371.10 / $371.10 / $371.10	Professional		$371.10	$371.10	$371.10
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.41 / $52.41 / $52.41	Professional	26	$52.41	$52.41	$52.41
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $318.69 / $318.69 / $318.69	Professional	TC	$318.69	$318.69	$318.69
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $257.58 / $303.05 / $387.86	Professional		$257.58	$303.05	$387.86
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.97 / $39.97 / $60.71	Professional	26	$33.97	$39.97	$60.71
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $223.62 / $263.08 / $276.49	Professional	TC	$223.62	$263.08	$276.49
United Facility/Professional Professional Modifier Low / Median / High Price $204.21 / $313.72 / $591.07	Professional		$204.21	$313.72	$591.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.43 / $50.65 / $82.73	Professional	26	$35.43	$50.65	$82.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $197.85 / $300.23 / $537.14	Professional	TC	$197.85	$300.23	$537.14