Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.32 / $26.32 / $110.41	Facility	26	$26.32	$26.32	$110.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.69 / $102.71 / $168.35	Professional		$67.69	$102.71	$168.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.41 / $25.71 / $39.81	Professional	26	$20.41	$25.71	$39.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.87 / $74.73 / $113.92	Professional	TC	$47.87	$74.73	$113.92
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $59.02 / $73.78 / $73.78	Professional		$59.02	$73.78	$73.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.00 / $24.81 / $54.21	Professional	26	$23.00	$24.81	$54.21
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $28.41 / $97.20 / $192.61	Professional		$28.41	$97.20	$192.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.23 / $116.98 / $189.59	Professional		$74.23	$116.98	$189.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.23 / $32.09 / $53.81	Professional	26	$19.23	$32.09	$53.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.97 / $82.23 / $139.87	Professional	TC	$51.97	$82.23	$139.87
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $112.04 / $138.06 / $188.15	Professional		$112.04	$138.06	$188.15
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $34.39 / $47.12	Professional	26	$29.51	$34.39	$47.12
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $86.30 / $103.66 / $141.03	Professional	TC	$86.30	$103.66	$141.03
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.27 / $93.26 / $143.44	Professional		$79.27	$93.26	$143.44
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.22 / $26.14 / $79.25	Professional	26	$22.22	$26.14	$79.25
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $57.05 / $68.92 / $124.99	Professional	TC	$57.05	$68.92	$124.99
United Facility/Professional Professional Modifier Low / Median / High Price $72.16 / $102.11 / $177.58	Professional		$72.16	$102.11	$177.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.98 / $29.70 / $48.33	Professional	26	$18.98	$29.70	$48.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $51.68 / $76.23 / $133.74	Professional	TC	$51.68	$76.23	$133.74