Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $20.42 / $97.72	Facility	26	$12.88	$20.42	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $87.10 / $251.19	Professional		$53.70	$87.10	$251.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $22.39 / $66.07	Professional	26	$12.88	$22.39	$66.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $56.23 / $131.83	Professional	TC	$38.90	$56.23	$131.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $53.70 / $102.33	Professional		$44.67	$53.70	$102.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $14.13 / $21.38	Professional	26	$12.02	$14.13	$21.38
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $54.95 / $63.10	Professional	TC	$52.48	$54.95	$63.10
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $16.22 / $26.92 / $194.98	Professional		$16.22	$26.92	$194.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $85.11 / $147.91	Professional		$53.70	$85.11	$147.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $19.95 / $32.36	Professional	26	$11.75	$19.95	$32.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $64.57 / $117.49	Professional	TC	$41.69	$64.57	$117.49
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $102.33 / $141.25	Professional		$85.11	$102.33	$141.25
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $20.42 / $28.18	Professional	26	$17.78	$20.42	$28.18
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $83.18 / $112.20	Professional	TC	$69.18	$83.18	$112.20
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $69.18 / $134.90	Professional		$58.88	$69.18	$134.90
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $15.49 / $33.88	Professional	26	$13.18	$15.49	$33.88
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $53.70 / $104.71	Professional	TC	$45.71	$53.70	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $70.79 / $123.03	Professional		$48.98	$70.79	$123.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $16.98 / $28.84	Professional	26	$10.96	$16.98	$28.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $53.70 / $95.50	Professional	TC	$38.90	$53.70	$95.50