Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.49 / $50.49 / $142.87	Facility	26	$50.49	$50.49	$142.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.73 / $97.92 / $246.96	Professional		$77.73	$97.92	$246.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.89 / $46.13 / $71.04	Professional	26	$39.89	$46.13	$71.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.19 / $48.90 / $75.73	Professional	TC	$38.19	$48.90	$75.73
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.24 / $98.36 / $180.27	Professional		$85.24	$98.36	$180.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.54 / $62.88 / $72.59	Professional	26	$40.54	$62.88	$72.59
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $48.37 / $138.80 / $380.00	Professional		$48.37	$138.80	$380.00
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $5,016.00 / $5,016.00 / $5,016.00	Professional	26	$5,016.00	$5,016.00	$5,016.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.44 / $125.16 / $234.62	Professional		$78.44	$125.16	$234.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.26 / $64.97 / $109.65	Professional	26	$33.26	$64.97	$109.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.30 / $68.52 / $128.18	Professional	TC	$43.30	$68.52	$128.18
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $108.43 / $141.12 / $182.72	Professional		$108.43	$141.12	$182.72
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.22 / $64.77 / $84.01	Professional	26	$50.22	$64.77	$84.01
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.21 / $76.34 / $98.71	Professional	TC	$58.21	$76.34	$98.71
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.47 / $85.71 / $140.44	Professional		$56.47	$85.71	$140.44
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.38 / $42.75 / $80.67	Professional	26	$35.38	$42.75	$80.67
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.51 / $51.33 / $87.13	Professional	TC	$41.51	$51.33	$87.13
United Facility/Professional Professional Modifier Low / Median / High Price $72.59 / $108.98 / $201.97	Professional		$72.59	$108.98	$201.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.75 / $50.15 / $94.96	Professional	26	$30.75	$50.15	$94.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.70 / $58.82 / $103.11	Professional	TC	$36.70	$58.82	$103.11