Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.20 / $46.20 / $123.50	Facility	26	$46.20	$46.20	$123.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.07 / $165.59 / $313.95	Professional		$130.07	$165.59	$313.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.00 / $46.35 / $87.32	Professional	26	$38.00	$46.35	$87.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.92 / $120.78 / $193.59	Professional	TC	$93.92	$120.78	$193.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.87 / $124.88 / $142.91	Professional		$102.87	$124.88	$142.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.07 / $41.99 / $68.02	Professional	26	$36.07	$41.99	$68.02
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $69.59 / $223.72 / $429.15	Professional		$69.59	$223.72	$429.15
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $47.97 / $82.52 / $236.00	Professional	26	$47.97	$82.52	$236.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.70 / $216.47 / $349.51	Professional		$125.70	$216.47	$349.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.67 / $59.48 / $97.73	Professional	26	$33.67	$59.48	$97.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.42 / $155.19 / $257.69	Professional	TC	$89.42	$155.19	$257.69
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $185.14 / $220.39 / $299.29	Professional		$185.14	$220.39	$299.29
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.68 / $61.75 / $105.87	Professional	26	$52.68	$61.75	$105.87
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.94 / $158.63 / $215.31	Professional	TC	$131.94	$158.63	$215.31
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $132.69 / $162.91 / $275.60	Professional		$132.69	$162.91	$275.60
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.64 / $45.36 / $156.11	Professional	26	$37.64	$45.36	$156.11
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.06 / $117.55 / $202.20	Professional	TC	$95.06	$117.55	$202.20
United Facility/Professional Professional Modifier Low / Median / High Price $116.89 / $171.36 / $303.95	Professional		$116.89	$171.36	$303.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.52 / $56.38 / $91.41	Professional	26	$34.52	$56.38	$91.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.33 / $136.37 / $230.40	Professional	TC	$87.33	$136.37	$230.40