Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $114.82 / $208.93	Facility	26	$27.54	$114.82	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $85.11 / $204.17	Professional		$64.57	$85.11	$204.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $42.66 / $107.15	Professional	26	$26.92	$42.66	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $50.12 / $100.00	Professional	TC	$38.02	$50.12	$100.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $77.62 / $77.62	Professional		$77.62	$77.62	$77.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $30.90 / $45.71	Professional	26	$24.55	$30.90	$45.71
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $60.26 / $162.18	Professional		$57.54	$60.26	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $104.71 / $173.78	Professional		$64.57	$104.71	$173.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $42.66 / $70.79	Professional	26	$25.12	$42.66	$70.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $63.10 / $109.65	Professional	TC	$38.90	$63.10	$109.65
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $112.20 / $338.84	Professional		$95.50	$112.20	$338.84
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $43.65 / $338.84	Professional	26	$37.15	$43.65	$338.84
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $69.18 / $338.84	Professional	TC	$57.54	$69.18	$338.84
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $85.11 / $165.96	Professional		$57.54	$85.11	$165.96
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $38.90 / $72.44	Professional	26	$28.84	$38.90	$72.44
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $63.10 / $123.03	Professional	TC	$42.66	$63.10	$123.03
United Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $87.10 / $151.36	Professional		$60.26	$87.10	$151.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $36.31 / $61.66	Professional	26	$23.44	$36.31	$61.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $51.29 / $91.20	Professional	TC	$35.48	$51.29	$91.20