Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $110.85 / $110.86 / $121.94	Facility	26	$110.85	$110.86	$121.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $156.72 / $187.60 / $283.95	Professional		$156.72	$187.60	$283.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $88.25 / $105.18 / $162.55	Professional	26	$88.25	$105.18	$162.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.08 / $79.70 / $121.87	Professional	TC	$67.08	$79.70	$121.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $159.37 / $159.37 / $220.12	Professional		$159.37	$159.37	$220.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $94.22 / $133.69 / $146.12	Professional	26	$94.22	$133.69	$146.12
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $173.18 / $243.20 / $549.38	Professional		$173.18	$243.20	$549.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.33 / $249.65 / $452.44	Professional		$120.33	$249.65	$452.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.81 / $148.97 / $267.99	Professional	26	$77.81	$148.97	$267.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.47 / $119.31 / $225.31	Professional	TC	$60.47	$119.31	$225.31
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $200.00 / $259.48 / $336.59	Professional		$200.00	$259.48	$336.59
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $116.68 / $150.47 / $195.18	Professional	26	$116.68	$150.47	$195.18
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.33 / $109.01 / $141.41	Professional	TC	$83.33	$109.01	$141.41
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $101.27 / $161.08 / $268.08	Professional		$101.27	$161.08	$268.08
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $83.16 / $100.45 / $170.53	Professional	26	$83.16	$100.45	$170.53
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.40 / $83.34 / $144.68	Professional	TC	$67.40	$83.34	$144.68
United Facility/Professional Professional Modifier Low / Median / High Price $128.84 / $193.19 / $368.65	Professional		$128.84	$193.19	$368.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.40 / $119.53 / $208.47	Professional	26	$77.40	$119.53	$208.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.23 / $95.53 / $172.68	Professional	TC	$58.23	$95.53	$172.68