Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.62 / $22.62 / $129.01	Facility	26	$22.62	$22.62	$129.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.71 / $97.21 / $262.70	Professional		$49.71	$97.21	$262.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.62 / $29.22 / $63.28	Professional	26	$22.62	$29.22	$63.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.96 / $74.59 / $116.54	Professional	TC	$10.96	$74.59	$116.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $39.22 / $44.18 / $74.69	Professional		$39.22	$44.18	$74.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.65 / $37.65 / $37.65	Professional	26	$37.65	$37.65	$37.65
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $63.02 / $93.71 / $204.71	Professional		$63.02	$93.71	$204.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.19 / $133.88 / $241.51	Professional		$47.19	$133.88	$241.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.94 / $40.72 / $75.70	Professional	26	$21.94	$40.72	$75.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.65 / $97.46 / $177.67	Professional	TC	$14.65	$97.46	$177.67
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $59.33 / $78.56 / $156.49	Professional		$59.33	$78.56	$156.49
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.67 / $56.50 / $97.07	Professional	26	$46.67	$56.50	$97.07
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $12.65 / $15.11 / $26.31	Professional	TC	$12.65	$15.11	$26.31
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.70 / $75.65 / $156.19	Professional		$59.70	$75.65	$156.19
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.08 / $30.23 / $79.11	Professional	26	$25.08	$30.23	$79.11
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.22 / $48.49 / $126.07	Professional	TC	$39.22	$48.49	$126.07
United Facility/Professional Professional Modifier Low / Median / High Price $40.38 / $101.05 / $171.86	Professional		$40.38	$101.05	$171.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.54 / $34.86 / $58.90	Professional	26	$24.54	$34.86	$58.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $8.15 / $60.99 / $116.18	Professional	TC	$8.15	$60.99	$116.18