Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $166.09 / $166.09 / $166.09	Facility	26	$166.09	$166.09	$166.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $210.96 / $259.91 / $364.04	Professional		$210.96	$259.91	$364.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $132.22 / $157.96 / $222.05	Professional	26	$132.22	$157.96	$222.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.84 / $104.53 / $147.36	Professional	TC	$79.84	$104.53	$147.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $253.34 / $264.07 / $462.12	Professional		$253.34	$264.07	$462.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $141.43 / $200.49 / $218.82	Professional	26	$141.43	$200.49	$218.82
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $280.77 / $280.77 / $290.97	Professional		$280.77	$280.77	$290.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.95 / $336.70 / $626.78	Professional		$169.95	$336.70	$626.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $115.09 / $222.90 / $394.85	Professional	26	$115.09	$222.90	$394.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.94 / $146.99 / $267.97	Professional	TC	$77.94	$146.99	$267.97
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $279.70 / $361.78 / $470.82	Professional		$279.70	$361.78	$470.82
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $174.84 / $224.79 / $292.75	Professional	26	$174.84	$224.79	$292.75
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $104.88 / $136.99 / $178.07	Professional	TC	$104.88	$136.99	$178.07
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.04 / $220.15 / $375.85	Professional		$120.04	$220.15	$375.85
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $122.54 / $148.01 / $248.85	Professional	26	$122.54	$148.01	$248.85
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $83.20 / $102.87 / $177.96	Professional	TC	$83.20	$102.87	$177.96
United Facility/Professional Professional Modifier Low / Median / High Price $193.29 / $296.52 / $589.94	Professional		$193.29	$296.52	$589.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $115.62 / $178.32 / $338.63	Professional	26	$115.62	$178.32	$338.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.05 / $122.39 / $227.82	Professional	TC	$67.05	$122.39	$227.82