Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.71 / $25.71 / $67.06	Facility	26	$25.71	$25.71	$67.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.36 / $209.15 / $392.69	Professional		$171.36	$209.15	$392.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.47 / $35.00 / $48.15	Professional	26	$21.47	$35.00	$48.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $142.68 / $177.51 / $303.87	Professional	TC	$142.68	$177.51	$303.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $117.01 / $117.01 / $146.26	Professional		$117.01	$117.01	$146.26
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.44 / $35.63 / $79.69	Professional	26	$29.44	$35.63	$79.69
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $284.57 / $284.57 / $284.57	Professional		$284.57	$284.57	$284.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $189.12 / $301.44 / $578.05	Professional		$189.12	$301.44	$578.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.97 / $42.02 / $86.09	Professional	26	$25.97	$42.02	$86.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $152.79 / $245.16 / $497.79	Professional	TC	$152.79	$245.16	$497.79
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $228.05 / $301.92 / $624.86	Professional		$228.05	$301.92	$624.86
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.59 / $53.91 / $113.96	Professional	26	$41.59	$53.91	$113.96
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $186.46 / $248.01 / $510.90	Professional	TC	$186.46	$248.01	$510.90
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $173.02 / $222.88 / $355.55	Professional		$173.02	$222.88	$355.55
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.35 / $36.51 / $249.10	Professional	26	$30.35	$36.51	$249.10
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $135.08 / $167.04 / $300.77	Professional	TC	$135.08	$167.04	$300.77
United Facility/Professional Professional Modifier Low / Median / High Price $149.77 / $220.38 / $413.82	Professional		$149.77	$220.38	$413.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.86 / $41.04 / $73.23	Professional	26	$21.86	$41.04	$73.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $132.51 / $199.27 / $381.30	Professional	TC	$132.51	$199.27	$381.30