Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.42 / $21.42 / $109.01	Facility	26	$21.42	$21.42	$109.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.81 / $103.76 / $203.76	Professional		$82.81	$103.76	$203.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.16 / $25.44 / $52.09	Professional	26	$20.16	$25.44	$52.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.92 / $78.23 / $132.52	Professional	TC	$59.92	$78.23	$132.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $22.12 / $41.53	Professional	26	$18.62	$22.12	$41.53
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $45.52 / $45.52 / $45.52	Professional		$45.52	$45.52	$45.52
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $30.12 / $40.79 / $74.13	Professional	26	$30.12	$40.79	$74.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.17 / $17.17 / $17.17	Facility	26	$17.17	$17.17	$17.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.13 / $123.20 / $224.29	Professional		$82.13	$123.20	$224.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.57 / $31.67 / $53.15	Professional	26	$18.57	$31.67	$53.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.65 / $94.24 / $177.48	Professional	TC	$54.65	$94.24	$177.48
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $106.04 / $157.72 / $231.46	Professional		$106.04	$157.72	$231.46
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.38 / $33.06 / $45.36	Professional	26	$28.38	$33.06	$45.36
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.18 / $137.36 / $186.12	Professional	TC	$114.18	$137.36	$186.12
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $105.43 / $127.51 / $178.06	Professional		$105.43	$127.51	$178.06
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.12 / $24.87 / $88.68	Professional	26	$21.12	$24.87	$88.68
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $87.26 / $102.66 / $157.02	Professional	TC	$87.26	$102.66	$157.02
United Facility/Professional Professional Modifier Low / Median / High Price $71.95 / $131.37 / $233.33	Professional		$71.95	$131.37	$233.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $29.24 / $49.98	Professional	26	$18.62	$29.24	$49.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.02 / $104.30 / $188.79	Professional	TC	$61.02	$104.30	$188.79