Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.30 / $29.31 / $94.00	Facility	26	$29.30	$29.31	$94.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.41 / $98.39 / $306.02	Professional		$77.41	$98.39	$306.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.30 / $35.72 / $80.01	Professional	26	$29.30	$35.72	$80.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.72 / $58.05 / $106.10	Professional	TC	$46.72	$58.05	$106.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $65.92 / $82.26 / $137.44	Professional		$65.92	$82.26	$137.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.49 / $34.18 / $59.89	Professional	26	$26.49	$34.18	$59.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $81.14 / $81.14 / $81.14	Professional	TC	$81.14	$81.14	$81.14
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $53.74 / $126.91 / $261.12	Professional		$53.74	$126.91	$261.12
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $42.30 / $57.66 / $93.51	Professional	26	$42.30	$57.66	$93.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $76.54 / $131.30 / $220.08	Professional		$76.54	$131.30	$220.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.11 / $48.07 / $80.45	Professional	26	$26.11	$48.07	$80.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.11 / $79.27 / $129.35	Professional	TC	$45.11	$79.27	$129.35
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $104.39 / $126.81 / $272.45	Professional		$104.39	$126.81	$272.45
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.56 / $46.79 / $217.19	Professional	26	$38.56	$46.79	$217.19
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $65.83 / $80.03 / $217.19	Professional	TC	$65.83	$80.03	$217.19
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $68.77 / $93.33 / $139.97	Professional		$68.77	$93.33	$139.97
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.84 / $35.97 / $94.69	Professional	26	$29.84	$35.97	$94.69
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $49.50 / $61.20 / $102.74	Professional	TC	$49.50	$61.20	$102.74
United Facility/Professional Professional Modifier Low / Median / High Price $70.52 / $107.18 / $184.29	Professional		$70.52	$107.18	$184.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.38 / $40.36 / $68.22	Professional	26	$26.38	$40.36	$68.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.18 / $66.93 / $116.07	Professional	TC	$44.18	$66.93	$116.07