Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.62 / $25.62 / $114.71	Facility	26	$25.62	$25.62	$114.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.12 / $91.12 / $199.79	Professional		$67.12	$91.12	$199.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.62 / $31.46 / $99.88	Professional	26	$25.62	$31.46	$99.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.86 / $54.95 / $96.86	Professional	TC	$40.86	$54.95	$96.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $55.49 / $68.15 / $135.27	Professional		$55.49	$68.15	$135.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.98 / $28.91 / $53.29	Professional	26	$22.98	$28.91	$53.29
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $72.00 / $72.00 / $72.00	Professional	TC	$72.00	$72.00	$72.00
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $33.09 / $102.68 / $233.37	Professional		$33.09	$102.68	$233.37
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $44.57 / $88.54	Professional	26	$33.11	$44.57	$88.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.67 / $113.49 / $195.42	Professional		$66.67	$113.49	$195.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.40 / $41.36 / $69.40	Professional	26	$22.40	$41.36	$69.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.75 / $70.39 / $119.99	Professional	TC	$40.75	$70.39	$119.99
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $92.02 / $111.61 / $240.17	Professional		$92.02	$111.61	$240.17
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.56 / $40.59 / $281.33	Professional	26	$33.56	$40.59	$281.33
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.45 / $71.03 / $281.33	Professional	TC	$58.45	$71.03	$281.33
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.99 / $72.50 / $119.60	Professional		$45.99	$72.50	$119.60
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.87 / $31.19 / $70.05	Professional	26	$25.87	$31.19	$70.05
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.76 / $64.38 / $157.55	Professional	TC	$43.76	$64.38	$157.55
United Facility/Professional Professional Modifier Low / Median / High Price $62.94 / $94.17 / $161.77	Professional		$62.94	$94.17	$161.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.57 / $34.86 / $58.03	Professional	26	$22.57	$34.86	$58.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.47 / $59.18 / $102.61	Professional	TC	$39.47	$59.18	$102.61