Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $42.66 / $162.18	Facility	26	$30.20	$42.66	$162.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $165.96 / $489.78	Professional		$95.50	$165.96	$489.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $36.31 / $112.20	Professional	26	$22.91	$36.31	$112.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $91.20 / $218.78	Professional	TC	$67.61	$91.20	$218.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $89.13 / $123.03	Professional		$79.43	$89.13	$123.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $23.44 / $36.31	Professional	26	$19.05	$23.44	$36.31
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $42.66 / $234.42	Professional		$19.05	$42.66	$234.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $144.54 / $257.04	Professional		$102.33	$144.54	$257.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $34.67 / $58.88	Professional	26	$24.55	$34.67	$58.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $109.65 / $204.17	Professional	TC	$77.62	$109.65	$204.17
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $128.82 / $204.17	Professional		$120.23	$128.82	$204.17
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $30.90 / $47.86	Professional	26	$27.54	$30.90	$47.86
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $97.72 / $154.88	Professional	TC	$91.20	$97.72	$154.88
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $100.00 / $263.03	Professional		$83.18	$100.00	$263.03
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $23.99 / $60.26	Professional	26	$20.42	$23.99	$60.26
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $75.86 / $213.80	Professional	TC	$63.10	$75.86	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $117.49 / $208.93	Professional		$91.20	$117.49	$208.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $28.84 / $51.29	Professional	26	$21.88	$28.84	$51.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $89.13 / $162.18	Professional	TC	$67.61	$89.13	$162.18