Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.35 / $18.35 / $77.31	Facility	26	$18.35	$18.35	$77.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.26 / $104.07 / $166.58	Professional		$67.26	$104.07	$166.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.44 / $18.35 / $27.50	Professional	26	$14.44	$18.35	$27.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.81 / $87.32 / $134.30	Professional	TC	$55.81	$87.32	$134.30
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.20 / $72.20 / $72.20	Professional		$72.20	$72.20	$72.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $14.27 / $16.12 / $33.47	Professional	26	$14.27	$16.12	$33.47
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $19.30 / $32.29 / $807.75	Professional		$19.30	$32.29	$807.75
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $16.01 / $36.00 / $53.29	Professional	26	$16.01	$36.00	$53.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.48 / $115.01 / $211.34	Professional		$72.48	$115.01	$211.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.20 / $23.06 / $37.81	Professional	26	$13.20	$23.06	$37.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.39 / $91.24 / $174.50	Professional	TC	$58.39	$91.24	$174.50
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $98.45 / $125.96 / $153.84	Professional		$98.45	$125.96	$153.84
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.85 / $22.84 / $33.36	Professional	26	$17.85	$22.84	$33.36
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $80.59 / $103.12 / $152.16	Professional	TC	$80.59	$103.12	$152.16
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $80.64 / $94.87 / $146.79	Professional		$80.64	$94.87	$146.79
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.83 / $17.84 / $98.14	Professional	26	$14.83	$17.84	$98.14
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $65.81 / $77.42 / $127.45	Professional	TC	$65.81	$77.42	$127.45
United Facility/Professional Professional Modifier Low / Median / High Price $66.47 / $98.95 / $173.68	Professional		$66.47	$98.95	$173.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.85 / $19.43 / $33.06	Professional	26	$12.85	$19.43	$33.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.96 / $82.75 / $145.88	Professional	TC	$57.96	$82.75	$145.88