Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.55 / $18.55 / $74.98	Facility	26	$18.55	$18.55	$74.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $68.75 / $91.09 / $171.03	Professional		$68.75	$91.09	$171.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.55 / $25.65 / $50.00	Professional	26	$18.55	$25.65	$50.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.19 / $69.95 / $105.87	Professional	TC	$51.19	$69.95	$105.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $57.23 / $65.93 / $65.93	Professional		$57.23	$65.93	$65.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.97 / $23.90 / $52.73	Professional	26	$20.97	$23.90	$52.73
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $31.20 / $74.80 / $194.18	Professional		$31.20	$74.80	$194.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.04 / $15.04 / $15.04	Facility	26	$15.04	$15.04	$15.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.16 / $104.19 / $178.77	Professional		$70.16	$104.19	$178.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.20 / $30.07 / $51.71	Professional	26	$20.20	$30.07	$51.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.62 / $76.12 / $136.10	Professional	TC	$47.62	$76.12	$136.10
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $104.77 / $131.72 / $181.65	Professional		$104.77	$131.72	$181.65
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.10 / $37.49 / $51.25	Professional	26	$32.10	$37.49	$51.25
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.95 / $96.14 / $130.40	Professional	TC	$79.95	$96.14	$130.40
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $80.04 / $94.17 / $125.39	Professional		$80.04	$94.17	$125.39
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.90 / $28.12 / $74.66	Professional	26	$23.90	$28.12	$74.66
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $56.14 / $67.81 / $112.90	Professional	TC	$56.14	$67.81	$112.90
United Facility/Professional Professional Modifier Low / Median / High Price $62.73 / $97.80 / $171.85	Professional		$62.73	$97.80	$171.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.32 / $30.68 / $50.38	Professional	26	$18.32	$30.68	$50.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.69 / $67.12 / $121.47	Professional	TC	$45.69	$67.12	$121.47