Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.87 / $82.87 / $82.87	Facility	26	$82.87	$82.87	$82.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.54 / $144.46 / $217.46	Professional		$118.54	$144.46	$217.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.89 / $78.80 / $122.11	Professional	26	$65.89	$78.80	$122.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.07 / $61.75 / $95.34	Professional	TC	$52.07	$61.75	$95.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $168.26 / $168.26 / $168.26	Professional		$168.26	$168.26	$168.26
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $70.68 / $109.67 / $126.58	Professional	26	$70.68	$109.67	$126.58
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $84.84 / $160.26 / $480.00	Professional		$84.84	$160.26	$480.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $103.64 / $187.70 / $343.64	Professional		$103.64	$187.70	$343.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.28 / $111.35 / $200.68	Professional	26	$58.28	$111.35	$200.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.60 / $92.50 / $174.67	Professional	TC	$47.60	$92.50	$174.67
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $153.07 / $198.64 / $257.64	Professional		$153.07	$198.64	$257.64
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.56 / $113.00 / $146.44	Professional	26	$87.56	$113.00	$146.44
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $65.51 / $85.64 / $111.20	Professional	TC	$65.51	$85.64	$111.20
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $80.97 / $118.86 / $202.96	Professional		$80.97	$118.86	$202.96
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.11 / $75.04 / $115.28	Professional	26	$62.11	$75.04	$115.28
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $52.41 / $64.81 / $110.01	Professional	TC	$52.41	$64.81	$110.01
United Facility/Professional Professional Modifier Low / Median / High Price $98.60 / $162.33 / $319.94	Professional		$98.60	$162.33	$319.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.12 / $88.05 / $162.72	Professional	26	$58.12	$88.05	$162.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.91 / $73.22 / $134.08	Professional	TC	$41.91	$73.22	$134.08