Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.28 / $33.28 / $108.09	Facility	26	$33.28	$33.28	$108.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.07 / $107.60 / $211.09	Professional		$88.07	$107.60	$211.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.28 / $39.78 / $85.77	Professional	26	$33.28	$39.78	$85.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.79 / $64.65 / $120.05	Professional	TC	$54.79	$64.65	$120.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $80.78 / $102.09 / $192.16	Professional		$80.78	$102.09	$192.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $32.00 / $59.40 / $67.89	Professional	26	$32.00	$59.40	$67.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $98.47 / $98.47 / $98.47	Professional	TC	$98.47	$98.47	$98.47
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $44.01 / $135.71 / $269.45	Professional		$44.01	$135.71	$269.45
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $42.43 / $79.73 / $119.83	Professional	26	$42.43	$79.73	$119.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.78 / $151.13 / $259.77	Professional		$84.78	$151.13	$259.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.90 / $54.55 / $91.68	Professional	26	$28.90	$54.55	$91.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.49 / $87.00 / $150.88	Professional	TC	$47.49	$87.00	$150.88
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $109.12 / $150.13 / $321.37	Professional		$109.12	$150.13	$321.37
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.33 / $53.04 / $113.09	Professional	26	$43.33	$53.04	$113.09
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.80 / $97.09 / $208.28	Professional	TC	$79.80	$97.09	$208.28
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.45 / $110.43 / $165.61	Professional		$81.45	$110.43	$165.61
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.79 / $40.74 / $109.29	Professional	26	$33.79	$40.74	$109.29
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $60.07 / $70.67 / $115.29	Professional	TC	$60.07	$70.67	$115.29
United Facility/Professional Professional Modifier Low / Median / High Price $73.45 / $115.13 / $213.47	Professional		$73.45	$115.13	$213.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.51 / $45.21 / $77.28	Professional	26	$28.51	$45.21	$77.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.09 / $79.00 / $137.21	Professional	TC	$48.09	$79.00	$137.21