Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.50 / $126.79 / $312.91	Professional		$84.50	$126.79	$312.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.47 / $34.59 / $58.85	Professional	26	$24.47	$34.59	$58.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.75 / $84.90 / $254.87	Professional	TC	$56.75	$84.90	$254.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $96.61 / $96.61 / $96.61	Professional		$96.61	$96.61	$96.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.33 / $51.33 / $63.55	Professional	26	$51.33	$51.33	$63.55
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $110.50 / $150.00 / $171.13	Professional		$110.50	$150.00	$171.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.11 / $128.75 / $243.14	Professional		$67.11	$128.75	$243.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.22 / $39.67 / $76.45	Professional	26	$21.22	$39.67	$76.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.42 / $86.47 / $188.78	Professional	TC	$45.42	$86.47	$188.78
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $128.50 / $183.57 / $260.27	Professional		$128.50	$183.57	$260.27
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.04 / $38.63 / $53.84	Professional	26	$27.04	$38.63	$53.84
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $101.46 / $144.94 / $206.43	Professional	TC	$101.46	$144.94	$206.43
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $111.36 / $143.16 / $228.89	Professional		$111.36	$143.16	$228.89
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.92 / $32.08 / $109.35	Professional	26	$25.92	$32.08	$109.35
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.77 / $112.67 / $228.89	Professional	TC	$95.77	$112.67	$228.89
United Facility/Professional Professional Modifier Low / Median / High Price $68.25 / $135.24 / $210.48	Professional		$68.25	$135.24	$210.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.86 / $33.11 / $54.44	Professional	26	$17.86	$33.11	$54.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.90 / $108.27 / $181.09	Professional	TC	$61.90	$108.27	$181.09