Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $138.50 / $138.50 / $138.50	Facility	26	$138.50	$138.50	$138.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $188.22 / $227.84 / $339.79	Professional		$188.22	$227.84	$339.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $110.15 / $131.58 / $186.19	Professional	26	$110.15	$131.58	$186.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $76.90 / $92.39 / $141.16	Professional	TC	$76.90	$92.39	$141.16
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $211.06 / $211.06 / $264.80	Professional		$211.06	$211.06	$264.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $117.97 / $167.29 / $182.69	Professional	26	$117.97	$167.29	$182.69
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $226.95 / $311.52 / $664.09	Professional		$226.95	$311.52	$664.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $145.22 / $296.45 / $541.66	Professional		$145.22	$296.45	$541.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $96.59 / $186.00 / $334.34	Professional	26	$96.59	$186.00	$334.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.50 / $138.01 / $261.48	Professional	TC	$69.50	$138.01	$261.48
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $239.98 / $310.92 / $403.85	Professional		$239.98	$310.92	$403.85
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $145.94 / $187.90 / $244.29	Professional	26	$145.94	$187.90	$244.29
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $94.03 / $123.03 / $159.54	Professional	TC	$94.03	$123.03	$159.54
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $111.38 / $186.80 / $317.10	Professional		$111.38	$186.80	$317.10
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.90 / $124.30 / $195.54	Professional	26	$102.90	$124.30	$195.54
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $77.20 / $95.46 / $167.96	Professional	TC	$77.20	$95.46	$167.96
United Facility/Professional Professional Modifier Low / Median / High Price $151.15 / $255.28 / $445.01	Professional		$151.15	$255.28	$445.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $94.30 / $145.86 / $284.39	Professional	26	$94.30	$145.86	$284.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.28 / $107.72 / $218.40	Professional	TC	$63.28	$107.72	$218.40