Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.70 / $107.03 / $176.58	Facility	26	$104.70	$107.03	$176.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $159.22 / $221.48 / $270.91	Professional		$159.22	$221.48	$270.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.74 / $78.78 / $85.67	Professional	26	$33.74	$78.78	$85.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.20 / $142.69 / $196.96	Professional	TC	$102.20	$142.69	$196.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $92.44 / $106.02 / $106.02	Professional		$92.44	$106.02	$106.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.02 / $47.10 / $77.45	Professional	26	$36.02	$47.10	$77.45
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $47.63 / $170.00 / $268.27	Professional		$47.63	$170.00	$268.27
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $39.18 / $74.34 / $107.38	Professional	26	$39.18	$74.34	$107.38
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $139.36 / $165.65 / $418.58	Professional		$139.36	$165.65	$418.58
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.94 / $60.51 / $60.51	Professional	26	$51.94	$60.51	$60.51
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.42 / $105.15 / $105.15	Professional	TC	$87.42	$105.15	$105.15
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $68.86 / $117.88 / $198.89	Professional		$68.86	$117.88	$198.89
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.21 / $42.60 / $94.74	Professional	26	$36.21	$42.60	$94.74
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $65.51 / $81.01 / $144.63	Professional	TC	$65.51	$81.01	$144.63
United Facility/Professional Professional Modifier Low / Median / High Price $103.50 / $154.27 / $256.00	Professional		$103.50	$154.27	$256.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.00 / $49.90 / $81.51	Professional	26	$34.00	$49.90	$81.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.91 / $109.64 / $170.10	Professional	TC	$61.91	$109.64	$170.10