Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.39 / $91.20 / $169.82	Facility	26	$22.39	$91.20	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $117.49 / $489.78	Professional		$61.66	$117.49	$489.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $39.81 / $81.28	Professional	26	$25.12	$39.81	$81.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $85.11 / $218.78	Professional	TC	$39.81	$85.11	$218.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $97.72 / $107.15	Professional		$67.61	$97.72	$107.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $26.30 / $51.29	Professional	26	$23.44	$26.30	$51.29
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $120.23 / $147.91	Professional		$120.23	$120.23	$147.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $125.89 / $239.88	Professional		$75.86	$125.89	$239.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $35.48 / $64.57	Professional	26	$19.95	$35.48	$64.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $93.33 / $181.97	Professional	TC	$54.95	$93.33	$181.97
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $141.25 / $194.98	Professional		$120.23	$141.25	$194.98
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $36.31 / $50.12	Professional	26	$30.90	$36.31	$50.12
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $104.71 / $144.54	Professional	TC	$87.10	$104.71	$144.54
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $104.71 / $154.88	Professional		$87.10	$104.71	$154.88
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $27.54 / $57.54	Professional	26	$23.44	$27.54	$57.54
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $77.62 / $125.89	Professional	TC	$48.98	$77.62	$125.89
United Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $112.20 / $199.53	Professional		$75.86	$112.20	$199.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $30.90 / $53.70	Professional	26	$20.89	$30.90	$53.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $83.18 / $151.36	Professional	TC	$56.23	$83.18	$151.36