Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.25 / $12.26 / $39.95	Facility	26	$12.25	$12.26	$39.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.68 / $53.65 / $130.13	Professional		$38.68	$53.65	$130.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.69 / $14.50 / $33.76	Professional	26	$11.69	$14.50	$33.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $38.60 / $66.80	Professional	TC	$26.30	$38.60	$66.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.00 / $42.35 / $54.82	Professional		$25.00	$42.35	$54.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.81 / $10.75 / $16.28	Professional	26	$8.81	$10.75	$16.28
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $28.43 / $28.43 / $28.43	Professional	TC	$28.43	$28.43	$28.43
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $16.82 / $61.09 / $102.30	Professional		$16.82	$61.09	$102.30
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $22.93 / $47.80	Professional	26	$13.80	$22.93	$47.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $10.00 / $10.00	Facility	26	$10.00	$10.00	$10.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.28 / $65.11 / $111.14	Professional		$40.28	$65.11	$111.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.36 / $17.75 / $30.50	Professional	26	$9.36	$17.75	$30.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.10 / $42.53 / $70.63	Professional	TC	$27.10	$42.53	$70.63
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $61.38 / $75.48 / $102.56	Professional		$61.38	$75.48	$102.56
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.69 / $17.25 / $23.41	Professional	26	$14.69	$17.25	$23.41
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.47 / $58.23 / $79.15	Professional	TC	$48.47	$58.23	$79.15
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.07 / $49.49 / $78.72	Professional		$42.07	$49.49	$78.72
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.00 / $12.96 / $50.19	Professional	26	$11.00	$12.96	$50.19
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.07 / $36.54 / $58.13	Professional	TC	$31.07	$36.54	$58.13
United Facility/Professional Professional Modifier Low / Median / High Price $39.97 / $52.91 / $93.85	Professional		$39.97	$52.91	$93.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.69 / $14.88 / $26.23	Professional	26	$9.69	$14.88	$26.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.62 / $41.37 / $70.92	Professional	TC	$28.62	$41.37	$70.92