Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $302.00 / $851.14	Facility	26	$91.20	$302.00	$851.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $371.54 / $977.24	Professional		$263.03	$371.54	$977.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $154.88 / $380.19	Professional	26	$91.20	$154.88	$380.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $239.88 / $501.19	Professional	TC	$158.49	$239.88	$501.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $257.04 / $316.23	Professional		$213.80	$257.04	$316.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $104.71 / $257.04	Professional	26	$85.11	$104.71	$257.04
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $199.53 / $549.54	Professional		$123.03	$199.53	$549.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $562.34 / $891.25	Professional		$275.42	$562.34	$891.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $141.25 / $239.88	Professional	26	$81.28	$141.25	$239.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $416.87 / $707.95	Professional	TC	$181.97	$416.87	$707.95
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $457.09 / $630.96	Professional		$389.05	$457.09	$630.96
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $151.36 / $204.17	Professional	26	$128.82	$151.36	$204.17
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $309.03 / $426.58	Professional	TC	$257.04	$309.03	$426.58
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $302.00 / $630.96	Professional		$245.47	$302.00	$630.96
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $114.82 / $245.47	Professional	26	$95.50	$114.82	$245.47
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $190.55 / $436.52	Professional	TC	$158.49	$190.55	$436.52
United Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $489.78 / $851.14	Professional		$275.42	$489.78	$851.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $128.82 / $218.78	Professional	26	$87.10	$128.82	$218.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $331.13 / $630.96	Professional	TC	$181.97	$331.13	$630.96