Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.66 / $112.20 / $257.04	Facility	26	$42.66	$112.20	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $181.97 / $489.78	Professional		$91.20	$181.97	$489.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $74.13 / $213.80	Professional	26	$34.67	$74.13	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $79.43 / $223.87	Professional	TC	$54.95	$79.43	$223.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $95.50 / $151.36	Professional		$74.13	$95.50	$151.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $38.90 / $69.18	Professional	26	$31.62	$38.90	$69.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $56.23 / $93.33	Professional	TC	$48.98	$56.23	$93.33
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $125.89 / $269.15	Professional		$43.65	$125.89	$269.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $141.25 / $251.19	Professional		$85.11	$141.25	$251.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $53.70 / $87.10	Professional	26	$31.62	$53.70	$87.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $83.18 / $151.36	Professional	TC	$50.12	$83.18	$151.36
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $134.90 / $186.21	Professional		$128.82	$134.90	$186.21
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $47.86 / $66.07	Professional	26	$45.71	$47.86	$66.07
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $89.13 / $123.03	Professional	TC	$83.18	$89.13	$123.03
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $114.82 / $218.78	Professional		$93.33	$114.82	$218.78
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $40.74 / $89.13	Professional	26	$34.67	$40.74	$89.13
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $74.13 / $158.49	Professional	TC	$63.10	$74.13	$158.49
United Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $114.82 / $208.93	Professional		$74.13	$114.82	$208.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $43.65 / $77.62	Professional	26	$28.84	$43.65	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $72.44 / $131.83	Professional	TC	$46.77	$72.44	$131.83