Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.55 / $23.55 / $121.93	Facility	26	$23.55	$23.55	$121.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.94 / $102.73 / $170.34	Professional		$84.94	$102.73	$170.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.71 / $27.68 / $43.02	Professional	26	$22.71	$27.68	$43.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $62.22 / $75.04 / $110.33	Professional	TC	$62.22	$75.04	$110.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.59 / $94.31 / $123.78	Professional		$72.59	$94.31	$123.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.73 / $25.52 / $57.61	Professional	26	$22.73	$25.52	$57.61
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $30.45 / $50.99 / $149.60	Professional		$30.45	$50.99	$149.60
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $33.03 / $58.30 / $154.38	Professional	26	$33.03	$58.30	$154.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.84 / $145.33 / $237.06	Professional		$78.84	$145.33	$237.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.64 / $38.04 / $62.13	Professional	26	$20.64	$38.04	$62.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.21 / $107.70 / $175.02	Professional	TC	$58.21	$107.70	$175.02
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $121.62 / $147.36 / $252.97	Professional		$121.62	$147.36	$252.97
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.11 / $37.54 / $64.70	Professional	26	$31.11	$37.54	$64.70
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $90.51 / $109.83 / $188.26	Professional	TC	$90.51	$109.83	$188.26
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $90.04 / $110.59 / $177.21	Professional		$90.04	$110.59	$177.21
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.21 / $28.48 / $122.99	Professional	26	$24.21	$28.48	$122.99
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.81 / $82.13 / $141.60	Professional	TC	$69.81	$82.13	$141.60
United Facility/Professional Professional Modifier Low / Median / High Price $82.87 / $117.89 / $204.32	Professional		$82.87	$117.89	$204.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.77 / $31.96 / $54.01	Professional	26	$20.77	$31.96	$54.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.64 / $89.05 / $154.81	Professional	TC	$60.64	$89.05	$154.81