Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.17 / $30.17 / $97.59	Facility	26	$30.17	$30.17	$97.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.16 / $83.97 / $168.16	Professional		$69.16	$83.97	$168.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.17 / $35.86 / $72.44	Professional	26	$30.17	$35.86	$72.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $49.35 / $85.96	Professional	TC	$38.90	$49.35	$85.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $75.65 / $84.39 / $151.30	Professional		$75.65	$84.39	$151.30
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.03 / $36.25 / $67.03	Professional	26	$27.03	$36.25	$67.03
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $39.65 / $97.34 / $180.09	Professional		$39.65	$97.34	$180.09
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $43.12 / $43.74 / $51.83	Professional	26	$43.12	$43.74	$51.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.26 / $122.19 / $210.95	Professional		$69.26	$122.19	$210.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.53 / $49.10 / $82.58	Professional	26	$26.53	$49.10	$82.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.90 / $69.95 / $118.20	Professional	TC	$39.90	$69.95	$118.20
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $97.31 / $118.20 / $253.98	Professional		$97.31	$118.20	$253.98
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.02 / $47.70 / $101.84	Professional	26	$39.02	$47.70	$101.84
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.30 / $70.50 / $152.16	Professional	TC	$58.30	$70.50	$152.16
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.72 / $87.73 / $136.63	Professional		$52.72	$87.73	$136.63
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.44 / $36.99 / $74.56	Professional	26	$31.44	$36.99	$74.56
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.13 / $50.74 / $85.18	Professional	TC	$43.13	$50.74	$85.18
United Facility/Professional Professional Modifier Low / Median / High Price $65.72 / $96.99 / $166.41	Professional		$65.72	$96.99	$166.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.37 / $39.34 / $70.17	Professional	26	$26.37	$39.34	$70.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.96 / $58.29 / $96.49	Professional	TC	$37.96	$58.29	$96.49