Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.13 / $54.44 / $232.33	Facility	26	$46.13	$54.44	$232.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $127.37 / $217.37 / $564.00	Professional		$127.37	$217.37	$564.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.68 / $51.30 / $136.61	Professional	26	$38.68	$51.30	$136.61
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $60.70 / $85.50 / $143.13	Professional	52	$60.70	$85.50	$143.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.29 / $146.72 / $251.00	Professional	TC	$87.29	$146.72	$251.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $89.24 / $102.64 / $131.07	Professional		$89.24	$102.64	$131.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.42 / $35.61 / $70.09	Professional	26	$27.42	$35.61	$70.09
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $116.96 / $116.96 / $116.96	Professional	TC	$116.96	$116.96	$116.96
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $70.28 / $155.13 / $883.50	Professional		$70.28	$155.13	$883.50
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $47.69 / $81.51 / $594.83	Professional	26	$47.69	$81.51	$594.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.25 / $37.25 / $37.25	Facility	26	$37.25	$37.25	$37.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.88 / $240.77 / $438.85	Professional		$107.88	$240.77	$438.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.28 / $58.00 / $102.52	Professional	26	$29.28	$58.00	$102.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.40 / $172.23 / $335.43	Professional	TC	$74.40	$172.23	$335.43
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $151.94 / $201.50 / $631.44	Professional		$151.94	$201.50	$631.44
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.66 / $53.40 / $552.52	Professional	26	$45.66	$53.40	$552.52
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $105.92 / $127.41 / $552.52	Professional	TC	$105.92	$127.41	$552.52
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $115.82 / $136.26 / $307.60	Professional		$115.82	$136.26	$307.60
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.29 / $40.35 / $77.09	Professional	26	$34.29	$40.35	$77.09
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.52 / $95.91 / $169.22	Professional	TC	$81.52	$95.91	$169.22
United Facility/Professional Professional Modifier Low / Median / High Price $117.60 / $194.41 / $316.83	Professional		$117.60	$194.41	$316.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.28 / $49.90 / $84.87	Professional	26	$32.28	$49.90	$84.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.22 / $132.29 / $236.94	Professional	TC	$81.22	$132.29	$236.94